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* 1. What is your first and last name?

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* 2. What is the address/town where you currently live?

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* 3. How did you hear about this event?

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* 4. Any additional family members joining?
*Family members MUST live in SAME household
(Enter total amount of individuals attending event including yourself)

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* 5. Not required at all, but are you okay with entering the water up to mid-shin deep, if needed?

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* 6. Will you and all participating family members take your temperature(s) prior to the event and only participate if your and their temperatures are less than 100.4 F?

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* 7. Do you understand that you/your family are not to participate in the event if you/they are sick or if any of the following symptoms are exhibited:
fever, cough, shortness of breath/difficulty breathing, sore throat, chills, unexpected muscle pain, unexpected fatigue, headache, congestion or runny nose, nausea/vomiting, diarrhea, or new lost of taste or smell in the last 14 days?

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* 8. Are you and your family committed to social distancing and proper hygiene, maintaining greater than 6 feet from non-family members, avoiding physical contact (i.e handshakes), washing/sanitizing hands appropriately, etc?

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* 9. Will you bring your own mask and sanitizer?

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* 10. Will you bring enough water for you and your family to stay hydrated for the duration of the event?
Note: Reusable thermoses are encouraged.

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* 11. Are you willing to be a team lead for your group?
This will include ensuring that social distancing is maintained and picking up supplies for your designated area before the event starts.

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* 12. The Volunteer understands that he/she is engaging in activities that may expose him/her to dangers both from known risks and unanticipated risks.
By signing this form (via digital completion of this survey), the Volunteer discharges and holds harmless Keep Aransas County Beautiful, LLC and its representatives from any and all liability, claims, losses, suits, damages, and demands of whatever kind or nature arising or resulting from property damage, bodily or personal injury and/or death that may be caused by Keep Aransas County Beautiful, LLC s negligence or otherwise. 
By signing this digital survey, the Volunteer also understands that Keep Aransas County Beautiful, LLC, its partners, and affiliates may use all photographic images, video or audio recordings, video or audio reproductions, films, radio or television broadcasts and any other reproductions of the activities without limitations. Permission is granted for use in any medium now known or hereafter developed, including printed media, video, still photography and the Internet.

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* 13. Would you like to receive our E-Newsletters to get involved in future events?  

Thank you for taking part in Keep Aransas County Beautiful's ongoing initiatives!
Keep Aransas County Beautiful, Inc
P.O. Box 1523 | Fulton, TX 78358
361-210-8300
info@kacbtx.org
www.kacbtx.org

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