CLEAN UP DEXTER ONLINE REGISTRATION FORM

Please complete the form below and our office will confirm project with you.

PROJECT DATE: * / MM / DD YYYY
PROJECT START TIME: * : HH MM AM/PM
PROJECT LOCATION: *
TYPE OF PROJECT *

TYPE OF PROJECT CLEAN UP BEAUTIFICATION OTHER OTHER
PLEASE DESCRIBE YOUR PROJECT: (ex. pick up litter along streets, plant flowers, pull weeds) *
PROJECT LEADER'S NAME: * First Last
ORGANIZATION: *
MAILING ADDRESS: *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
EMAIL: *
BEST PHONE#: * - ### - ### ####
ALTERNATE #: - ### - ### ####
NUMBER OF VOLUNTEERS: *
IS YOUR PROJECT OPEN TO THE PUBLIC? *

IS YOUR PROJECT OPEN TO THE PUBLIC? YES, ANYONE CAN JOIN US NO, ONLY OUR VOLUNTEERS ARE INVITED
PLEASE IDENTIFY YOUR SOURCE OF VOLUNTEERS: (check all that apply) *
NEIGHBORHOOD RESIDENTS BUSINESS OR COMPANY SCHOOL CHRUCH GROUP SCOUT TROOP COURT-ORDERED COMMUNITY SERVICE OTHER OTHER
PLEASE REVIEW: *
I HAVE READ AND I AM AWARE OF THE VOLUNTEER RECOMMENDATIONS AS PROJECT LEADER I WILL CONDUCT AN ORIENTATION/SAFETY TALK BEFORE ACTIVITIES BEGIN I WILL TAKE PICTURES AND EMAIL FOR USE ON CITY OF DEXTER SOCIAL MEDIA
DRAW YOUR SIGNATURE IN BOX BELOW: *

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