Event*

Event Date

First Name*

Last Name*

Other Names Used

Texas Driver's License

Street Address

Apartment #

City

State
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Home Phone Number

Alternative Phone Number

E-Mail Address

Place of Employment

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EMERGENCY CONTACT INFORMATION:

Emergency Contact Name*

Relationship to applicant

Emergency Contact Phone #*

Hospital Preference

In the event of an emergency does the staff of Keep Brazos Beautiful have your consent to obtain medical services for you?*
Yes
No

Have any health conditions/limitations past or present which may be affected by the service you provide during this event?*
Yes
No

If so, please explain

Ever been convicted of any felonies and/or misdemeanors which prohibit you from working with or within the same vicinity of minors?*
Yes
No

Do you agree to allow Keep Brazos Beautiful and its affiliates to use my photograph and name for any and all promotional purposes?*
Yes
No

Would you be interested in volunteering for any of the following? Check marks declare a YES answer.
This event again next year?
Texas Trash Off
Trash Truck Pull
Litter Free Events
Annual Banquet
Annual Tree Sale
Campus Clean-ups
Planet Earth Day
Arbor Day
Litter Tackle Box
Litter Posse
Wildflower Campaign
Community Tool Shed Program
Texas Recycles Day
Office Help
Web Design
Y.E.L.L. (Young Environmental Leaders League)
KBB Board of Directors

I agree to complete the duties required within the work shift I have been designated and will notify the appropriate staff person within ample time if I am unable to do so. I agree there will be zero tolerance on behalf of KBB for any use or influence of alcohol, controlled, or illegal substances while on grounds designated for KBB purposes and events and during volunteer performance. I also agree not to have any such substance in my possession during this time. *I agree to have a criminal background check performed at the expense of KBB mandated for volunteers working with minors on any level. (Only required for those volunteers working with youth events) I agree to notify KBB designated staff of any concerns I have while participating in the fore mentioned event. I HEREBY CERTIFY THAT THE ABOVE INFORMATION IS ACCURATE. I ALSO HEREBY, FOR MY GROUP, MEMBERS, AGENTS, & VOLUNTEERS, FOR MYSELF, MY HEIRS, & EXECUTORS, WAIVE AND RELEASE ANY & ALL CLAIMS FOR DAMAGES THAT MAY ARISE AND/OR FOR ANY TYPE OF INJURIES OR LOSSES INCURRED WHILE PARTICIPATING AND/OR VOLUNTEERING IN OR IN CONJUNCTION WITH THE ABOVE MENTIONED EVENT.*
Yes
No