DID YOU KNOW?
Clean up Pack Request
Address Line 2
Clean Up Details
Location of Proposed Clean Up
Number of People Attending
I Agree to the Liability Waiver
Every volunteer (including the Site Supervisor) must complete this form before participating in the Clean Up.
The information collected will only be used by Stormwater Shepherd and will not be shared with any third parties.
The participants or legal guardian signed below agree that Spel Stormwater PTY LTD and the local Clean Up organisers will not be
• any injuries sustained by the participant
• any loss or damage to property owned by, or in the possession of, the participant
• any acts or omissions, negligence or fault of any person participating in the Clean Up
The participants or legal guardian signed below agree that they:
• will take reasonable care for their own safety
• will accompany and supervise all volunteers 15 years of age or under who are registered under their signature
• will wear sturdy enclosed footwear, gloves and protective equipment as advised by Spel Stormwater PTY LTD
• will not do anything to harm themselves or other volunteers
• will not handle syringes or other sharps but will inform the Site Supervisor immediately
• Will use all safety equipment they are given
• have told the Site Supervisor of any pre-existing medical conditions that might affect their participation in the Clean Up
• have read and understand the Risk Warning notice displayed at this Clean Up Site
• Are not affected by drugs or alcohol
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