Macon's 12th Annual River Cleanup

Saturday October 8, 2016 8:30 to 11:30 AM (rain date 10/15)

Name Organization/Company

Street City State

email

Enter the number of participants you are registering: Child

Number of T-shirts needed (to get a shirt, must sign up by 9/23/16):

Adult small

Adult medium

Adult large

Adult x-large

Important!! Each participant must complete attached Release & Liability Waiver form and bring on the day of event. Persons under 18 years of age must have a parent or guardian sign. Read "Think Safety!" All ages are welcome but children must be accompanied by an adult at all times. By submitting this form you acknowledge these requirements.

Mark Wyzalek - 464-5678 ocmulgee_alive@maconwater.org

phone

zip

Adult 2x-large

1. Use the sign up below to register and submit by email. 2. Cleanup locations will be pre-assigned by email. If you know a stream to clean - let us know!! 3. Any volunteers without a pre-assigned location will need to meet @ 8:15 AM at Amerson River Park.

Corporate Sponsors

Macon Water Authority Macon Water Environmental Education, Inc.

in conjunction with NewTown Macon/Ocmulgee Heritage Trail

Keep Macon-Bibb Beautiful

MEDICAL RELEASE, PHOTO RELEASE, & LIABILITY WAIVER FORM Voluntary - My participation in this River Cleanup is voluntary. I will select the activities in which I will participate. I will choose activities that are within my physical capacities. I will stay away from the water if I cannot swim or if I have any open cuts. Assumption of Risk - I realize that during this Cleanup, there are several ways that I could potentially hurt myself if I am not careful or choose a task that I am not capable of doing. For example, I might choose to (a) clean up slippery stream and river banks, (b) canoe in or wade in streams or rivers that may contain strong currents or uneven bottoms, (c) clean up near highways or roads, (d) cut vegetation with sharp tools, (e) pick up sharp items, and (f) clean up in or near a stream or river that may contain harmful pollutants, bacteria, or parasites. I realize that my participation in any of these activities is strictly voluntary and that I assume the risks associated with these activities. I could: (a) receive cuts and abrasions, (b) lose personal property such as watches or jewelry, and (c) suffer serious bodily injury. Waiver - - I release the sponsors, organizers, volunteers, and site property owners (as well as all of their affiliates, directors, officers, trustees, employees, representatives, or agents) from all actions or claims of any kind that relate to my participation in the Cleanup. I understand and acknowledge that this waiver binds my heirs, administrators, executors, personal representatives, and assigns. Hold Harmless - I hold the sponsors, organizers, volunteers, and site owners harmless and indemnify them against all actions or claims (including reasonable attorneys' fees, judgments and costs) with respect to any injuries, death, or other damages or losses, resulting from my participation in the Cleanup. Medical Treatment - If I am injured during the Cleanup, the organizers or volunteers of the Cleanup may render medical services to me or request that others provide such services. By taking such action, the organizers and volunteers are not admitting any liability to provide or to continue to provide any such services and that such action is not a waiver by the organizers or volunteers of any rights under this release and waiver. Should I require transport to a medical facility as a result of an injury, I am financially responsible for such transportation and medical treatment costs. If I am injured during the Cleanup, it is my responsibility to seek appropriate medical care and to notify the Cleanup organizers. I understand that this waiver will have no bearing on any workers compensation claims that I may make as a result of my participation in this event. Pictures - I agree that any pictures or videos taken of me or my children during the cleanup can be used for future promotional campaigns. I UNDERSTAND AND AGREE WITH THE CONTENTS OF THIS DOCUMENT. ANY QUESTIONS I MAY HAVE HAD ABOUT THIS DOCUMENT WERE ANSWERED TO MY SATISFACTION. Participant's Signature: Parent's Signature (participant is under 18): Printed Name: Printed Name: Date: Address: e-mail: Emergency Contact person and telephone number: Think Safety! - Bring insect repellent, tool to pick up trash, heavy duty work gloves, sunscreen, water or other liquid to drink Your safety and health is very important to us. There are several key points to keep in mind when you are preparing for a Rivers Alive event. During rain events, stream levels can rise rapidly causing bacteria levels to increase. We urge volunteers to avoid cleaning during high flows, thoroughly wash your hands after cleaning, and always work in pairs. Look out for poison ivy, snakes and bees so be conscious of your surroundings. To ensure a fun and educational trip to your stream, wetland or lake, please keep these simple precautions in mind:

>Always visit a site in pairs so one can go for help if the other is unable to

>Never work if the water is flooding or after a heavy rain - fast moving water is very dangerous

>Avoid steep banks as access points; wear a life jacket if near deep water

>Avoid touching your face and be sure to wash hands before eating

>Know the location of the nearest phone or take a cell phone with you

>Have an emergency plan ready - who will go for help? Does anyone know CPR?

>Does anyone have allergies?

>Be conscious of wildlife such as snakes, alligators and snapping turtles -leave them alone and they will leave you alone

>Look out for broken glass, poison ivy, ticks, bees, fire ants, and other hazards

>Wear high topped boots with sturdy non-skid soles or other similar footwear, a hat for sun protection, long sleeve shirt & long pants - tuck

pants in your boots or tie the bottoms for extra protection against ticks/poison ivy