Volunteer Details

PLEASE READ - INSURANCE:

The participant (registered below) agrees that:
- They are covered under Keep Australia Beautiful WA’s personal accident and public liability insurance policy for volunteers only during the time they are signed on for the activity and on the date given above.
- Keep Australia Beautiful will not be liable for: any acts or omissions, negligence or fault of any person participating in the activity; any loss or damage to property owned by, or in the possession of the participant.
- The participant is only covered by KAB WA insurance if all details are true and correct.

Please note:
- Parents / Guardians must accompany and sign this form on behalf of any children under 16 years of age.
- A separate registration must be done for each participant.

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* 1. PLEASE READ - INSURANCE:

The participant (registered below) agrees that:
- They are covered under Keep Australia Beautiful WA’s personal accident and public liability insurance policy for volunteers only during the time they are signed on for the activity and on the date given above.
- Keep Australia Beautiful will not be liable for: any acts or omissions, negligence or fault of any person participating in the activity; any loss or damage to property owned by, or in the possession of the participant.
- The participant is only covered by KAB WA insurance if all details are true and correct.

Please note:
- Parents / Guardians must accompany and sign this form on behalf of any children under 16 years of age.
- A separate registration must be done for each participant.

Please enter the following information to register for the Toodyay Road Cleanup.
It is important that a separate registration is completed for each person.

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* 2. Please enter the following information to register for the Toodyay Road Cleanup.
It is important that a separate registration is completed for each person.

Are you over 16?

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* 3. Are you over 16?

Which of the following best describes your main usual activity?

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* 4. Which of the following best describes your main usual activity?

Do you have any medical conditions, allergies, disabilities or past or present injuries that may affect your participation (eg back injury)?

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* 5. Do you have any medical conditions, allergies, disabilities or past or present injuries that may affect your participation (eg back injury)?

Time available - I can help out between:

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* 6. Time available - I can help out between:

I will stay for the Thankyou BBQ after the clean-up (after midday):

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* 7. I will stay for the Thankyou BBQ after the clean-up (after midday):

Dietary requirements:
We will attempt where possible to cater for dietary requirements, however resources are limited.

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* 8. Dietary requirements:
We will attempt where possible to cater for dietary requirements, however resources are limited.

Are you attending as part of a community group?  If so please state the group/s name/s:

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* 9. Are you attending as part of a community group?  If so please state the group/s name/s:

Additional information:

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* 10. Additional information:

I declare that I am in good mental and physical fitness and know of no physical disorder which should keep me from participating in this activity.

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* 11. I declare that I am in good mental and physical fitness and know of no physical disorder which should keep me from participating in this activity.

PHOTO CONSENT
By registering and attending this event, you are consenting to having your photograph taken.
I hereby grant the Eastern Metropolitan Regional Council (EMRC), City of Swan and Keep Australia Beautiful WA (KAB WA) permission to use / publish all recorded image(s) taken at the Toodyay Road Litter Cleanup April 28, 2018 of myself / my child / persons to which I am a guardian, in perpetuity, without compensation and at the absolute discretion of the EMRC, City of Swan and KAB WA for purposes including but not limited to activities promoting or supporting the City of Swan, KAB WA, EMRC, member councils, Perth’s Eastern Region and / or related communities, businesses, associations and organisations. I grant these rights on the understanding that I / we have no interest in the copyright of the images recorded.

If you don't agree please do not fill in the section below and identify yourself at the Registration Desk on the morning of the event.

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* 12. PHOTO CONSENT
By registering and attending this event, you are consenting to having your photograph taken.
I hereby grant the Eastern Metropolitan Regional Council (EMRC), City of Swan and Keep Australia Beautiful WA (KAB WA) permission to use / publish all recorded image(s) taken at the Toodyay Road Litter Cleanup April 28, 2018 of myself / my child / persons to which I am a guardian, in perpetuity, without compensation and at the absolute discretion of the EMRC, City of Swan and KAB WA for purposes including but not limited to activities promoting or supporting the City of Swan, KAB WA, EMRC, member councils, Perth’s Eastern Region and / or related communities, businesses, associations and organisations. I grant these rights on the understanding that I / we have no interest in the copyright of the images recorded.

If you don't agree please do not fill in the section below and identify yourself at the Registration Desk on the morning of the event.

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Image

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