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Registration for Citywide Litter Pick Up Day - October 16, 2021, - 8 a.m. - Noon

  1. litter banner cropped
  2. Registration for 10/16/21 Citywide Litter Pick Up Day

    Grab your family and friends to pick up litter in your own neighborhood or elsewhere in the City of Lewiston where you see a need. Churches and community groups are encouraged to adopt an area! Thank you for helping us keep Lewiston clean & beautiful!

  3. A REGISTRATION FORM MUST BE SUBMITTED BY EACH PARTICIPANT - PARENT OR GUARDIAN MUST COMPLETE FOR EACH MINOR.
  4. Participation Status
  5. Minor/Adult Status
  6. LITTER DISPOSAL - PLEASE INDICATE PICK UP METHOD TO BE USED
  7. Safety Guidelines (Check to Agree)
  8. PARTICIPATION WAIVER - PART I
    I agree to follow the COVID19 guidelines set forth for this litter pick up activity. Should I be diagnosed with COVID19 within 14 days of this activity, I will immediately notify my clean-up team leader (if on a team) and the City of Lewiston by phone: (207) 513-3000, X3450 or by email: dispatch@lewistonmaine.gov
  9. PARTICIPATION WAIVER - PART II
    I affirm that I have the health, physical ability, and necessary skills required to participate in this litter pick up. I have no knowledge of any condition which could endanger me or other participants. I agree to assume all risks involved in participation in this activity, including those that are not foreseeable.
  10. PARTICIPATION WAIVER - PART III
    As a City of Lewiston volunteer/event participant, I hereby give full right and permission to the City of Lewiston only to take, record, use, and publish any photo, video of or including my participation without restriction and use my likeness and voice in any photography, video, or film, to include others granted permission by the City of Lewiston to use my likeness in any photography, video, or film and release. I understand that I will not be compensated for any described usage above.
  11. PARTICIPATION WAIVER - PART IV
    I hereby release and discharge the City of Lewiston, Maine, its agents, employees, officers, successors and assigns from all claims, demands, actions, judgments and executions which the undersigned ever had, or now has, or may have, for all personal injuries, known or unknown, and injuries to property, real or personal, caused by or arising out of the above-described activity which may result from causes beyond the control of, and without the fault or negligence of the City of Lewiston, their agents, employees, officers, successors and assigns.
  12. PLEASE NOTE: Parent or Guardian Must Use His/Her Name if Participant is Under 18.
  13. Leave This Blank:

  14. This field is not part of the form submission.