Baytown’s Don’t Mess with Texas Trash-Off
Saturday, April 11, 2015
Individual and/or Group Trash-Off Registration and Waiver Form:
As a Participant or Parent/Guardian/Responsible Adult of a Participant in Baytown’s Don’t Mess With Texas
Trash-Off event, I hereby release, discharge and agree to hold harmless Keep Baytown Beautiful, Inc., the
City of Baytown, and all other property owners and sponsors, their agents, employees, officers and successors from all liability, claims
or actions which I, my heirs, executors, administrators or assigns may have or claim to have against any of them arising from any personal injuries or
other claims connected therewith, whether known or unknown, or injuries to other persons or to property caused by or arising out of any actions I might
take relating to my activities while participating in the above event. If the participant is a minor, I as parent or guardian of the participant further
authorize Keep Baytown Beautiful, Inc. and other participating property owners, sponsors and employees of these organizations to obtain emergency
medical treatment for the participant should an apparent need for this treatment arise. I understand that, if child(ren) I supervise is/are under the
age of 15, I will arrange for me or my other designated Adult to remain with them throughout their participation in this event. I have carefully
read this release and understand all its terms. I sign it voluntarily and with full knowledge of its legal consequences.
T-shirts & sizes are Limited, So Pre-Register or Come out Early to be Sure You Get One! ADULT SIZES: S, M, L, XL, XXL, XXXL YOUTH SIZES: S, M, L
ADULT REGISTRATIONS / WAIVERS:
Printed Adult Name:
With what Neighborhood, Civic, Youth, or Business
Group do you wish to be associated?
Signature:
T-Shirt
Size:
______________________________ ______________________________ __________________________________________________________ _______
(First Adult)
(Required)
______________________________ ______________________________ __________________________________________________________ _______
(Second Adult)
(Required)
Full Address / Zip Code: ______________________________________________, TX____________ Day-Time Phone: ____________________________
YOUTH / MINOR REGISTRATIONS: (At least one Parent, Guardian or responsible Adult must sign below for any Youth / Minor participant.)
Printed Youth / Minor Name:
Grade:
With what Neighborhood, Civic, Youth, Business
Group do you wish to be associated?
School Attending:
T-Shirt Size (Note if it’s
Adult or Youth):
______________________________ __________ ______________________________ __________________________________________ _______
(First Minor)
______________________________ __________ ______________________________ __________________________________________ _______
(Second Minor)
______________________________ __________ ______________________________ __________________________________________ _______
(Third Minor)
 Adult Signature Required for Minors:
Date:
Day-Time Phone, if not listed above:
How would you like to participate? (Please check all categories that apply)
Neighborhood Clean-up
Street Clean-up
Alleyway Clean-up
Park Clean-up
Serve as Support Staff for Event
Wherever you need me, assign me.
Registrations Forms may be faxed to (281) 420-7184. For more information, contact Keep Baytown Beautiful, Inc. (281) 420-5384.