Waterway Steward Application

I have read and understand the KPB Waterway Steward Program Guidelines(Required)

KPB Waterway Steward Program Guidelines(.pdf)

Yes

I have read and understand the KPB Waterway Cleanup Manual(Required)

KPB Waterway Cleanup Manual (.pdf)

Yes

PRIMARY CONTACT INFORMATION

(must be 18 years of age)

Name(Required)

First Last

Organization affiliation (if any)

Mailing address(Required)

The Waterway Cleanup Kit will be shipped to this address.

Street Address Address Line 2 City State ZIP / Postal Code

PA county for your mailing address(Required)

Adams, Berks, York, etc.

Phone (home or cell)(Required)

Phone (work)

Email(Required)

Enter Email Confirm Email

From where did you hear about the Waterway Stewards program?(Required)

KPB newsletter, KPB Facebook post, KPB Affiliate, DEP newsletter, etc.

Signature

Signature(Required)

Keep Pennsylvania Beautiful reserves the right to revoke or refuse a steward application.

By typing your name and the date below you are signing the application and verifying that the primary contact is at least 18 years of age. The primary contact agrees to:

Make safety a top priority and review the KPB Waterway Steward Program Guidelines(.pdf) and KPB Waterway Cleanup Manual (.pdf).
Waterway Stewards release liability as stated below. For additional volunteers who will participate in a cleanup, please email Michelle Dunn at mdunn@keeppabeautiful.org prior to each cleanup to obtain waiver forms. One form per participant is required. Completed forms can be uploaded at the time of reporting data.
Coordinate a minimum of two cleanups per year. Waterway Stewards are welcome to conduct and report more cleanups!
Report your results within 2 weeks of each cleanup.
Volunteer's Release from Liability
1. Voluntary Participation: By clicking here, I acknowledge that I have voluntarily applied to assist in projects undertaken with PA CleanWays d/b/a Keep Pennsylvania Beautiful (“Projects”), projects in which volunteers participate in Waterway Steward cleanups and activities. I understand as a volunteer that I will not be paid for my services, that I will not be covered by any medical or other insurance coverage provided by PA CleanWays d/b/a Keep Pennsylvania Beautiful, and that I will not be eligible for any Workers Compensation benefits.
2. Release: In consideration of the opportunity afforded me to assist in this Project, by clicking here I hereby agree that I, my assignees, heirs, guardians, and legal representatives, will not make a claim against PA CleanWays d/b/a Keep Pennsylvania Beautiful, or any of its affiliated organizations, or either of their officers or directors collectively or individually, or the supplier of any materials or equipment that is used by the Projects, or any of the volunteer workers, for the injury or death to me or damage to my property, however caused, arising from my participation in the Projects. Without limiting the generality of the foregoing, I hereby waive and release any rights, actions, or causes or action resulting from personal injury or death to me, or damage to my property, sustained in connection with my participation in the Projects. I further consent to the unrestricted use by PA CleanWays d/b/a Keep Pennsylvania Beautiful or persons authorized by them of any photographs, recordings, interviews, videotapes, motion pictures, or similar visual recording of me.

Today's date(Required)

Questions? Please contact Michelle Dunn at 724-836-4121 ext. 113 or mdunn@keeppabeautiful.org.