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Earth Day - Great Global Cleanup Registration Form

April 19 to 25, 2020

Registration deadline is April 1, 2020

Please feel free to bring your own gloves.

Contact Information

Applicant Name

Date of Application

Organization Name

Alternate Contact

Street Address

City

Province

Postal Code

Phone

Alternate Phone

E-Mail

In the event we receive inquiries regarding participating in this event, please provide contact information that can be made available to the public who wish to cleanup at your location.

Name

E-Mail

Phone

Cleanup Information

Cleanup Location

Team Name

Date(s) of Cleanup

Start Time

End Time

Number of Cleanup Participants

Number of Cleanup Vehicles

Suggested Garbage Pickup Location

Parks staff will only pick up collected garbage on City property, (i.e. parks, trails). Registration will be accepted for private property locations in order to assemble cleanup kits. It is the responsibility of any private property cleanup organizers to take collected garbage to the landfill or to make arrangements to properly dispose of collected garbage.

Note: The garbage pickup location must be accessible to Parks and Recreation vehicles. Call 519-756-1500 or email parksandrecreation@brantford.ca if you are unsure.

Other Information

Applicant Signature

Applicant Name

Agree

Yes

Personal information on this form is collected under the authority of section 10(1) of the Municipal Act, 2001, as amended and will be used solely to contact persons making application for a community cleanup location with the City of Brantford. Questions about this collection should be directed to the Director of Parks Services, 1 Sherwood Drive, Brantford, ON N3T 1N3, (519) 756-1500.