Group Registration Form - 2014

Please take pictures pre and post event!

PRE EVEN !NF"R#$!"N
1. The site supervisor's name is: _______________________________________________
Email: ________________________________________________________________
Phone number(s) Cell: ______________________ Other: _____________________
2. Organization our group is representing: ______________________
!. Pro"e#te$ % o& parti#ipants: _________ '$ults _________ Chil$ren
(. )ave ou i$enti*e$ an inlan$ area ou +ish to target, -es./o
0. 1& es please spe#i&: ____________________________________________
2. 1& no (() +oul$ ou li3e &or the 4CT to assign ou to su#h a lo#ation, -es./o
5. 1& our team is ma$e o& man #hil$ren or ou pre&er a bea#h please in$i#ate
+hi#h bea#h ou +oul$ li3e to target. __________________________________
6. 1& ou have i$enti*e$ a lo#ation in$i#ate +here the re&use +ill be lo#ate$ &or
pi#3 up: ___________________________________________________________
7. 8h have ou #hosen to parti#ipate in Clean 9p :arba$os 2;1(,
1. Team :uil$ing 2. <o something goo$
2. Communit parti#ipation 5. -ou +ere tol$ to
!. Parti#ipate in <ata Colle#tion 6. 8ant to have &un
(. -ou have an interest in the
environment
9. Other: please spe#i& belo+
0. -ou have a$opte$ our area __________________________
Please note:
Site Supervisors, will be responsible for their group
All Group members, parents/guardians must sign acceptance of the Clean Up Barbados conditions
on the Group Sign On Sheet for 2014
o liabilit! will be accepted b! "uture Centre #rust or b! Clean Up #he $orld Pt! %td for:
o An! sustained in&uries b! an! participant
o An! loss or damage to propert! owned b!, or in the possession of the participant
o An! acts or omissions, negligence or fault of an! person participating in the activit!'
Provision of "irst Aid (it is suggested and the responsibilit! of the Site Supervisor
)efreshments are the responsibilit! of the Site Supervisor, unless otherwise advised b! "uture Centre
#rust'
*+uipment and inputs received from the "C# ,as available-: Gloves and Bags, some tools as
available
.ue care must be ta(en with an! tools issued for the event' /t is the Site Supervisors responsibilit! to
return an! e+uipment bac( to #he "uture Centre #rust in reasonable condition at the post event
meeting or within one wee( of the event' An! loss or damage will be the responsibilit! of the
borrower'
Signed: .ate:
%uturecentretrust&gmail'com
This year we are encouraging clean-up teams to focus on inland areas which
may have litter or an illegal dumpsite. Teams with children are encouraged
however to register for beach locations.