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Volunteer Waiver

First Name

Last Name

Date of Birth

Name of Parent/Guardian

Address

I declare that the info I’ve provided is accurate & complete.

I hereby acknowledge this release from liability for accidental injury or illness which I may incur as a result of participating in any District Cleanups activity. I hereby assume all risks connected therewith and consent to participate in this program. I agree to disclose my physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in this program.

Thank you!

Let's make things better!

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