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3rd Annual TC Waterway Cleanup Sign Up


Thank you for participating in the 3rd Annual Treasure Coast Waterway Cleanup! 

The effort that you are making today is the inital step to seeing that our waterways are cleaner year-round.

Please complete this form and identify the area you prefer to work.

Please Follow The Basic Safety Rules:
Always wear closed toed shoes.
Please provide adult supervision for all minors.
Please examine all liter for sharp edges before picking up.
Hats, sunscreen, gloves and water are strongly suggested.

 


Liability Release Form 


In consideration of the privilege of being allowed to take part in the Marine Industries Association of the Treasure Coast 3rd Annual Waterway Cleanup, use the equipment and the facilities of the Association, and for other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the undersigned, individually and/or on behalf of my minor child named below do hereby agree to indemnify and hold harmless the Marine Industries Association of the Treasure Coast, its trustees, elected and appointed officials, agents, servants, volunteers and employees from and against all claims, demands, causes of action of whatsoever kind, and for any resulting judgments, losses, costs, damages, liability, expenses, including, but not limited to attorneys' fees arising out of, occurring during or relating to the use of the equipment, facilities, or participation in the Marine Industries Association of the Treasure Coasts 3rd Annual Waterway Cleanup.

 I further acknowledge and authorize the photograph and videotape and publication of such photographs and videotapes of myself and/or my minor child to promote or publicize the Marine Industries Association of the Treasure Coast 3rd Annual Waterway Cleanup.

 I understand the physical requirements of participation in these activities and affirm that my child and/or I meet(s) these requirements. I give permission for coordinators, staff and emergency personnel to make necessary first aid decisions in the event of accident, injury or illness. In the case of injury, accident, illness or inability to complete these activities, I will bear the full cost of any expense incurred due to any injury to myself and/or my child or damage to my property.

 
1.

Please enter the information indicated below.


By entering my personal information, I consent to receive email communications from the survey author's organization based on the information collected.

First Name:
Last Name:
Company Name:
Work Phone:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province
(US/Canada):
Postal Code:

2.

Boat Name and Location

 

  • 50 characters left.
3.

Team Name

 

  • 50 characters left.
4.

Team Coordinator-Captain

 

  • 50 characters left.
5.

Team Members and T-shirt sizes

 

  • 1000 characters left.
6.

Martin County Sites

 

 

LeightonPark Ramp
Jimmy Graham Boat Ramp (Hobe Sound)
Sandsprit Park
Jensen Beach Causeway Ramp
Jensen Beach Boat Ramp (Indian River Drive)
Pecks Lake Reef Dive Cleanup
Other  
7.

St. Lucie County Sites

Rivergate Park Ramp
Prima Vista Ramp
Harbortown Marina
Manatee Center Ramp
Ft. Pierce Yacht Club
Stan Blum Ramp
Pelican Yacht Club
Smithsonian Marine Ecosystems Exhibit South Causeway Island Ramp
Other  
8.


Indian River County Sites

Riverside Park Ramp
Vero Beach Municipal Marina
Loggerhead Marina
Sebastian Main Street Boat Ramp
Sebastian Inlet State Park
Other