INTERNATIONAL COASTAL CLEANUP
September 19, 2015
Site Coordinator Registration Form
The International Coastal Cleanup (ICC) is a global initiative led by The Ocean Conservancy. This
cleanup event has taken place across the globe for the past 30 years. Last year, 684,015
volunteers joined the cleanup effort; nearly 2,000 in Lee County! This cleanup event is
scheduled for Saturday, September 19th, 2015.
The Coastal Cleanup is the only cleanup where trash is collected and recorded. The data cards
are then sent to the Ocean Conservancy where the information is used in the development of
new environmental protection acts and change the behaviors that cause marine debris in the
first place. The data cards are designed to have groups of 4 working together, 3 to collect litter
and debris and 1 to record the findings. Latex gloves will be provided, however some of the
marine debris will be rough so please feel free to bring work gloves.
The 2 goals of the cleanup are to remove unsightly and environmentally harmful debris from
Florida's coastlines and raise awareness about this preventable litter problem. Litter poses a
threat to wildlife - plastic bags are mistaken for jellyfish and eaten by sea turtles. Lost and
discarded fishing tackle is eaten by birds and becomes an entangling death trap to many types
of animal life.
The first 1,000 volunteers, who pre-register, will receive a free T-shirt. Cleanup volunteers are
provided with garbage bags and gloves. Safety vests, litter sticks and additional supplies are
available by request. In an effort to reduce the number of plastic bottles introduced into our
waste stream, we recommend volunteers bring reusable water bottles.
All dumpster and beautification requests must be submitted in writing, and include a map, to
the KLCB office no later than 2 weeks BEFORE your requested cleanup date to be considered for
the ICC. This cleanup is a county wide effort, focused on our shorelines and waterways.
Volunteers are encouraged to choose a location in their local community to help clean and
beautify! Lakes, rivers, canals, and shorelines are great locations for volunteers to participate in
the International Coastal Cleanup. Volunteers may also join in one of our community
coordinated cleanups. This is a great opportunity for students to earn community service
hours!
Community Coordinated Locations:
Bonita Springs (check in at Lover's Key Event Field)
Bunche Beach
Cape Coral - Horton Park
Fort Myers Beach Elementary School
KLCB is a private/non-profit organization with 501(c)(3) status, Fed. Tax I.D. #59-2977558.
INTERNATIONAL COASTAL CLEANUP
September 19, 2015
Site Coordinator Registration Form
Please make sure to fill this form out completely.
Supplies are on a FIRST COME FIRST SERVE BASIS
Organization/Group:_____________________________________________________________
Contact Name: ____ ____________________________________________________________
Contact Email: __________________________________ Phone: _________________________
(We will be using your email to add you to our Contact Database. This is used by KLCB, Inc. for cleanup and event
information distribution only)
Location of Event: ______________________________________________________________
Time of Event: _____________ to ___________
Estimated number of volunteers to participate in event: _______________________________
Dumpster Request: Yes _____ No _____ Purpose ____________________________________
(We do not provide dumpster for horticultural materials)
All dumpster requests must be submitted in writing, and include a map, for review and approval no later than 2
weeks before their requested cleanup date. If approved, requestor will be required to sign a KLCB Dumpster/Rolloff agreement. Request must state location for dumpster placement and must have approval by property owner
for placement.
Only one T-shirt per volunteer. These are limited supplies and are not promised. KLCB, Inc. will do its
best to provide you with all supplies requested.
Supplies Requested
ITEM
# Requested
Trash Bags
Safety vests (need to be worn when working on roadside 1 per 3 volunteers)
Gloves (1 glove per volunteer – unless request is for additional)
Water** If available (please encourage volunteers to bring reusable bottles)
*Beautification Tools (rakes, shovels, litter sticks) – Please specify
Additional Items (please list)
*Items must be returned to the KLCB office no later than 1 week from cleanup completion date – These are limited
supplies intended for borrowing purposes only.
Small
T-shirt Request
Medium
Large
X-Large
Total: ________
Please return any unused items to the KLCB office. KLCB is a non-profit organization with limited resources.
KLCB is a private/non-profit organization with 501(c)(3) status, Fed. Tax I.D. #59-2977558.
INTERNATIONAL COASTAL CLEANUP
September 19, 2015
Site Coordinator Registration Form
Thank you for partnering with Keep Lee County Beautiful, Inc. (KLCB) to help clean up our
waterways. To ensure that your cleanup efforts are successful, please take the time to read
and understand your responsibilities within this agreement.
Keep Lee County Beautiful will provide ________________________________ with _________
number of roll off dumpster(s) for casual litter and debris removal services on the date(s) of
__________________
for
the
purpose
of
waterway
cleanup
in
the
____________________________ community.
All requests to deliver and remove the project dumpster(s) must be made through your KLCB
contact directly. Please do not ask the driver for extensions of time or special pick up requests.
No tires, paints, batteries, household chemicals, vehicular fluids or electronics should be placed
in the project dumpster. These items are not permitted at the Waste to Energy (WTE) Facility.
If these items are found in the dumpster when it is transported to the WTE facility,
_________________________________will be responsible for any additional charges imposed
by the WTE for the disposal of the above named items.
Please make sure ALL members of your group understand what items cannot be placed in the
project dumpster.
Project Address: (include a copy of written permission from the property owner and include a map with
placement directions)
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Again, thank you for your efforts to help Keep Lee County Beautiful!
Neighborhood/Community/Organization Requesting Dumpster Service
Contact Name (print)
Phone
Signature Neighborhood Representative
Date
Keep Lee County Beautiful Representative
Trish Fancher
Date
KLCB is a private/non-profit organization with 501(c)(3) status, Fed. Tax I.D. #59-2977558.
INTERNATIONAL COASTAL CLEANUP
September 19, 2015
Site Coordinator Registration Form
Volunteer Safety Waiver & Photo Release
The Volunteer understands that he/she is engaging in activities that may expose him/her to dangers
both from known risks and unanticipated risks. By signing this from the Volunteer discharges and holds
harmless the Board of Directors, Keep Lee County Beautiful, Inc., officers, servants, agents or employees
(hereinafter referred to as RELEASEES) from any and all liability, claims, losses, suits, damages, and
demands of whatever kind or nature arising or resulting from property damage, bodily or personal injury
and/or death that may be caused by Keep Lee County Beautiful, Inc.’s negligence or otherwise.
By signing this form the Volunteer also understands that Keep Lee County Beautiful, Inc., its partners,
and affiliates may use all photographic images, video or audio recordings, video or audio reproductions,
films, radio or television broadcasts and any other reproductions of the activities without limitations.
Permission is granted for use in any medium now known or hereafter developed, including printed
media, video, still photography and the Internet.
Date: ___________________ Location of Event: _____________________________________________
Name of Volunteer
Email Address & Phone Number
Signature (parent signature if
volunteer under 18)
KLCB is a private/non-profit organization with 501(c)(3) status, Fed. Tax I.D. #59-2977558.
INTERNATIONAL COASTAL CLEANUP
September 19, 2015
Site Coordinator Registration Form
WRAP-UP REPORT
Please submit your wrap-up report on time. It is very important for reporting purposes.
______________________________________________________________________________
Organization/Community Group
Date of Event
______________________________________________________________________________
Contact Person
Phone
Email Address
Event Information
Number of Volunteers
_____ Number of bags of litter collected
_____
# of hours project took to
complete
# of flowers or shrubs planted
_____ # of bags of recyclables collected
_____
_____ # of appliances collected
_____
# of trees planted
_____ # of furniture items collected
_____
# of tires collected
_____
_____
_____ Railroad Cleanup
_____
Waterway Cleanup
_____ School/Campus Cleanup
_____
Church Cleanup
_____ Park Cleanup
_____
Other
_____
Please check all that apply:
Roadside Cleanup
Approximately hoe many Miles of Cleanup __________
Description of project/Location:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Please fill out “WRAP-UP” report and mail back to Keep Lee County Beautiful, Inc.
st
Please include any pictures of your event no later than October 1 .
KLCB is a private/non-profit organization with 501(c)(3) status, Fed. Tax I.D. #59-2977558.