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2. 
4. Group Name*
6. Proposed Date for Your Cleanup
   Proposed Date for Your Cleanup

   Please try and have your cleanup between April 22 and May 11, 2025.  All totals must be reported by May 14 to be included in the prize drawings. 

8. Clean Up Location*

   If your group knows what area of Town you plan to cleanup, list it here.  Use neighborhood names, road names and other descriptive information so we know where you will be doing your cleanup!

10. Name (Primary Contact)*
11. Email Address*
13. Address*
15. City*
16. State*
17. Zip Code*
19. Phone Number*
20. Approximate Number in Clean Up Group*

    Please let us know how many people you anticipate having at your cleanup, so we can get you the proper amount of gear.

21. Age Range *

    What is the age range of participants in your group?  Children under 15 must be accompanied by a parent or guardian during cleanup events. 

23. First Name (Secondary Contact)*
24. Last Name*
26. Phone Number*
27. Email Address*
29. Gear Request

    1. Trash Bags
    2. Reusable Gloves
    3. Safety Vests
    4. Trash Grabbers (limited supply)
    5. Step-in signs (CAUTION! Volunteers At Work)

    Please indicate what items you would like to use for your cleanup.  We will provide all groups with requested gear.  Safety Vests are required for all group cleanups.  If your group has your own supplies, please leave blank. 

31. Agreement

    The work will be performed under and in accordance with the Town of Fort Mill Stormwater Department's Volunteer Program Conditions and Safety Guidelines (both on website and incorporated herein by reference).

    Applicants to whom a Team Up to Clean Up Program Designation and Agreement are issued shall at all times indemnify and save harmless the Town of Fort Mill and all of its employees, agents and officers, from responsibility, damage, or liability arising from the exercise of the privileges granted under designated programs.  The Program Designation and Agreement may be terminated by the Town of Fort Mill at any time.  The Town of Fort Mill reserves the right to revise or discontinue the Volunteer Program at any time. 

    I understand that all participants in my group must complete a standard waiver form before the cleanup event. 

33. As a designated representative of the group listed above, I have read, understand and shall comply with the Team Up to Clean Up General Program Conditions and Safety Guidelines regarding participation in the program*

    1. I agree
35. Electronic Signature*

    Type your name and this will act as your electronic signature 

36. Date*
    Date
Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit Submit and Print

* indicates a required field