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* 1. Individual or Group Registration?

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* 2. Contact information?

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* 3. Number of participants?

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* 4. T-shirt requests (Please fill in needed totals for each size)?

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* 5. If cleaning a private property, please provide the address.

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* 6. If choosing to another cleanup date, please specify.

Date / Time

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* 7. River Walk, Saturday, October 1, 2016 Cleanup sites
All River Walk cleanup sites are reserved for kids age 10 with the supervision of adults age 18 and older.

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* 8. Columbus, Saturday, October 1, 2016 Cleanup Sites

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* 9. Phenix City and Russell County, Saturday, October 1, 2015 Cleanup Sites

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* 10. Waiver:
I having been granted permission to participate in Help The Hooch do hereby waive any and all claims of liability for personal injury, death or property damage against Keep Columbus Beautiful, the Columbus, Georgia Consolidated Government, all elected officials thereof,  and all directors,  supervisors, officers, employees and agents of Columbus, Georgia.

I further hereby release and indemnify Keep Columbus Beautiful, Columbus, Georgia, all elected officials thereof, and all directors, supervisors, officers, employees and agents of Columbus, Georgia, from all liability and responsibility that may be claimed or placed against such entity or persons by myself or others as a result of my participation in Help The Hooch.

I grant to Keep Columbus Beautiful, Columbus, Georgia, the right to take photographs of me and my family in connection with the above-identified event. I authorize Keep Columbus Beautiful, Columbus, Georgia, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that Keep Columbus Beautiful, Columbus, Georgia may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.

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