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Street Litter Clean Up Waiver

  1. Town of Fort Mill Litter Program

    Note: All clean-up participants must sign this form. Signature of a parent/guardian is required if participant is less than eighteen (18) years of age. 

    Please read the form carefully.  By typing your name and submitting this form, you are electronically signing this waiver.  Paper versions are also available if you prefer. 

  2. The name of the group or organization with which you are participating in this volunteer clean up

  3. Informed Consent, Liability & Hold Harmless, Publicity Permission

    I understand that on one or more occasions I/my child will be performing stream clean-up work as part of the Town sponsored volunteer program. 

    Said work will be performed with the support and direction of the above-mentioned  Group participating in the litter program. 

    I have read, and am familiar with, the General Program Conditions and Safety Guidelines provided to me by the Group, and agree to comply with said conditions and guidelines. 

    I understand that litter clean-up activities have a potential risk of injury. 

    I agree that I/my child will only perform those activities that I am/my child is capable of doing and able to do, and I acknowledge and assume the risks of all such activities. 

    I understand that participation in the clean-up activities is strictly voluntary and that I/my child may cease the volunteer activity at any time. 

    I agree that I will not hold the Group or the Town of Fort Mill or any of its agents, officers, employees, or representatives responsible for any damage or injury to me/my child or my/my child’s property as a result of volunteer participation in the volunteer program. I further agree to release, indemnify and hold harmless the Group and the Town of Fort Mill and all of its agents, officers, employees, representatives, successors and assigns from any and all damages, claims and/or liability arising out of my/my child’s activities as a volunteer stream clean-up participant in the volunteer program. 

    I give permission to the Town of Fort Mill Stormwater Department to include me/my child in any video productions or photographs that are made to document or publicize the volunteer activities. 

  4. Informed Consent*

    By checking the box, you are accepting the terms and conditions in this waiver of consent, liability & hold harmless and publicity policy. 

  5. If the participant is over age 18, please sign.  If participant is under age 18, a parent/guardian must sign

  6. If signed by a parent/guardian

  7. If signed by a parent/guardian

  8. Leave This Blank:

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