School Registration Form - 2014

To be filled out by Site Supervisor (group leader)

Please take pictures pre and post event!

PRE EVENT INFORMATION

1. The site supervisor's name is: _______________________________________________
Email: ________________________________________________________________
Phone number(s) Cell: ______________________ Other: _____________________
2. School your group is representing: ______________________

3. Projected # of participants: _________ Adults _______________ Children

IMPORTANT: As your group will consist of volunteer participants under 15 years of age,
parent/guardian consent must be granted for each child.

4. Your desired clean up location is: ______________________

5. The refuse will be located for pick up at: ______________________

6. Why have you chosen to participate in Clean Up Barbados 2014?



















1. Team Building 6. Do something good
2. Community participation 7. You were told to
3. Participate in Data Collection 8. Want to have fun

4. You have an interest in the
environment
9. Other: please specify below

5. You have adopted your area __________________________

Please note:
Site Supervisors, will be responsible for their group
All Group members, parents/guardians must sign acceptance of the Clean Up Barbados
Conditions on the School Group Sign On Sheet for 2014 / consent form (These will be sent
upon submission of this registration form)
No liability will be accepted by Future Centre Trust or by Clean Up The World Pty Ltd for:
o Any sustained injuries by any participant
o Any loss or damage to property owned by, or in the possession of the participant
o Any acts or omissions, negligence or fault of any person participating in the activity.
Provision of First Aid kit is suggested and the responsibility of the Site Supervisor
Refreshments are the responsibility of the Site Supervisor, unless otherwise advised by
Future Centre Trust.
Equipment and inputs received from the FCT (as available): Gloves and Bags, some tools as
available
Due care must be taken with any tools issued for the event. It is the Site Supervisors
responsibility to return any equipment back to The Future Centre Trust in reasonable
condition at the post event meeting or within one week of the event. Any loss or damage will
be the responsibility of the borrower.
Signed: Date:
PLEASE FAX THIS FORM TO: (246) 620 2021OR EMAIL A SCANNED COPY TO:
futurecentretrust@gmail.com
Though this years focus is on inland areas which may have
litter or an illegal dumpsite. Teams with children are
encouraged to register for beach locations.