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2. 
4. Registration - October 21, 2023, Citywide Litter Pick Up Day

   Invite your family and friends to pick up litter in your own neighborhood or elsewhere in the City of Lewiston where you see a need. Thank you for helping us keep Lewiston clean and beautiful!

   Public Works staff will be at Kennedy Park to provide bags, gloves, pickers, buckets, and safety guidelines.

6. A REGISTRATION FORM MUST BE SUBMITTED BY EACH PARTICIPANT - PARENT OR GUARDIAN MUST COMPLETE FOR EACH MINOR.
8. Participant's Name
9. Participant's Minor/Adult Status

   1. Minor (Under 18)
   2. Adult (18 & Over)
10. Parent or Guardian's Name if Participant is a Minor
12. Participant's Email Address (Parent or Guardian if Participant is a Minor)
13. Participant's Telephone Number (Parent or Guardian if Participant is a Minor)
15. Participation Status

    1. 1) Individually Participating
    2. 2) Participating as Part of a Team
    3. 3) Participating as a Team Leader
16. If Part of a Team, List Team Name
17. If Part of Team, Name of Team Leader
19. SPECIFIC LOCATION OF LITTER PICK UP
21. LITTER DISPOSAL - WHICH METHOD WILL YOU USE?

    1. Will return litter to Kennedy Park for disposal; Public Works collection vehicles will be on site.
    2. Request Public Works to pick up litter at specified site included above ON THIS FORM.
    3. Will call Public Works Dispatch the MORNING OF THE EVENT stating a pick-up location (513-3000, X3450).
    4. Dispose of collected litter through a participant's weekly trash collection.
23. Safety Guidelines (Check to Agree)

    1. Will wear gloves & remove safely.
    2. Will use hand sanitizer when gloves are removed.
    3. Wash hands with soap/warm water for at least 20 seconds at end of litter pick up.
    4. Will adhere to safety guidelines provided at Kennedy Park.
24. PARTICIPATION WAIVER - PART I

    I agree to follow any 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:  pwdispatch@lewistonmaine.gov

    (Parent or guardian would be affirming/agreeing as outlined above on behalf of minor who is being signed for.)

26. 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.  

    (Parent or guardian would be affirming/agreeing as outlined above on behalf of minor who is being signed for.)

27. 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.

    (Parent or guardian would be giving full right and permission outlined above on behalf of minor who is being signed for.)

29. 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. 

    (Parent or guardian would be affirming/agreeing to release and discharge as outlined above on behalf of minor who is being signed for.)

31. Date of Registration/Agreement to All Parts of Waiver
33. TYPE SIGNATURE: Typed Signature & Submitted Form Demonstrates Agreement to All Aspects of the Above Waiver For Myself or the Minor For Whom I am Signing.

    PLEASE REMEMBER: Parent or Guardian Must Sign the Form if Participant is a Minor (Under 18).

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35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

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