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!
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: firstname.lastname@example.org
(Parent or guardian would be agreeing as outlined above on behalf of minor who is being signed for.)
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 outlined above on behalf of minor who is being signed for.)
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 an permission outlined above on behalf of minor who is being signed for.)
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 agreeing to release and discharge as outlined above on behalf of minor who is being signed for.)
PLEASE NOTE: Parent or Guardian Must Sign the Form if Participant is a Minor (Under 18).
This field is not part of the form submission.
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