Annual SPRING and FALL Clean Up Events Fall Clean-up 2017 dates: Sept 23rd, 29th, and 30th Annual SPRING/FALL Clean-Up Events - Application Form * We require the completion of the entire application. Date: Name of Non-Profit Organization/Community Club/Group: Location of Non-Profit Organization/Community Club/Group: Primary Contact Full Name & NPO Title (Project Coordinator): Phone: Email: Address: This is Application for: Spring Clean-up Fall Clean-up Will the Coordinator be responsible for all volunteers during clean up? Yes No If no, the alternate coordinator must attend. (Coordinator is responsible to direct volunteers, to make sure the appropriate amount of volunteers shows up, and to relay the important clean-up information to volunteers as given by Adopt-A-Block upon acceptance). Secondary Contact Full Name & NPO Title (Alternative Coordinator): Phone: Email: Address: Which category does your organization fit into? Cultural Educational Seniors Youth Arts Heritage Health Athletics Environmental Other If Other: Description of Organization, (significance in community, member description, including group age(s), etc): What programs or services within your organization will benefit from the remuneration of this clean-up? (Service Clubs must let us know which group will benefit from their participation): Who currently sponsors your organization? Will all volunteer participants be members of your organization? Yes No If NO, please explain: Number of volunteers proposed for the litter clean- up. Must meet requirement of 15 volunteers MINIMUM. To a MAXIMUM of 25 volunteers: What are the ages of your volunteers for this clean- up? No volunteers under age 10 permitted – our liability coverage prohibits participation under this age: If your group is selected to participate in our annual clean-up, which is your first choice? A REGULAR (street side) clean-up A STREAM clean-up Note: Our Stream Clean-Up is only available in the Fall (one day ONLY - see Clean-up Calendar for dates), and all volunteers must be over the age of 16. *Check here if your group DOES NOT want to be considered for the STREAM Clean-up: No STREAM Clean-up What is your PREFERRED date to participate in our clean-up? (See Clean-up Calendar for dates): What is your ALTERNATIVE date for the clean- up? (See Clean-up Calendar for dates): (We will try to accommodate your preferred/alternate days, but this does not guarantee that we can schedule your group these days – be prepared to accept any date if selected.) Do you understand the clean- up goes on, rain or shine? Yes No Do you understand that clean-ups CAN NOT be rescheduled? Yes No Will you be prepared with sufficient water, refreshments, protective clothing, rain gear, gloves, etc. as needed? Yes No Will you guarantee completion of a short post clean- up survey? Yes No We can not stress enough the importance of: *Garden/work gloves can come in handy when there is large or heavy litter to collect – make sure to have a couple pairs to share amongst your volunteers * Make sure you are properly dressed for the rain or sun – and advise your volunteers to do the same. * Water resistant footwear is essential for a successful clean-up – and required for stream clean-ups. Application Completed By: Phone: Email: ADDRESS WHERE, IF SELECTED, PARTICIPANT INFORMATION PACKAGE WILL BE SENT! Address (Inc. Postal Code): IMPORTANT NOTE: •Applications accepted until January 30th (Spring Clean-up) and August 31st (Fall Clean-up) •Late applicants will NOT be considered for Spring/Fall Clean-Up participant selection •All applications will be selected through a lottery process following application deadline and selected applicants will be notified within 2 weeks of deadline and receive further information regarding Spring/Fall Clean-Up participation VERY IMPORTANT CHANGE AS OF SPRING 2013: We have changed our rules on funding. All selected groups will be given a chance to earn up to $400. This will be based on the number of volunteers that complete the cleanup. Groups will receive $20 per volunteer up to a total of $400. The routes will remain designed to accommodate groups from 15-25 people. 3+4=?