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Clemmons Quaran-Clean 2021

  1. Do you need Crosby Scholar Hours?
  2. Date must be a minimum of 48 hours from when form is submitted
  3. Do you have participants under the age of 13? *
  4. Are you a HandsOn NWNC participant?
  5. Ex: 3715 Clemmons Road - please leave on bench beside front door
  6. Number of Shirts and Sizes (only for people participating in the cleanup)
  7. Adult Small
    (out of stock)
  8. Adult Medium
    (out of stock)
  9. Adult Large
    (out of stock)
  10. Adult XL
    (out of stock)
  11. By submitting this form, I understand that as a participant in a Village event, I recognize that there is a risk of harm, or injury exists and agree to hold harmless the Village. I also agree to the following rules and guidelines listed in the Safety Bulletin below..*
  12. Safety Bulletin
    Clemmons Quaran-Clean 2021 March 1 – May 31, 2021 Thank you for participating in this year’s virtual Community Cleanup. Please follow these rules to ensure everyone stays safe during this cleanup. • DO NOT TAKE ANYTHING THAT IS NOT YOURS • All volunteers must wear reflective vests • All volunteers must wear gloves • All volunteers must wear a mask and practice social distancing • No more than six (6) people to a group • Stay off the railroad tracks if you are assigned that area. • Each group must appoint a spotter/supervisor to watch for traffic and to protect the group • Streets must be crossed as a group, no individuals wandering in the street or crossing alone • Must cleanup both sides of the street • Everyone must walk facing on-coming traffic and not have their backs to the traffic. • Stay within the right of way. Do not go into people’s yards. • Everyone needs to watch what they pick up. If it looks suspicious (ex: drug paraphernalia), or looks like chemicals/batteries, or anything in this nature, please call us to report it. • Be careful with “stuff” in bags. Do not stick your hand down in any paper or plastic bags. • Do not open anything with liquid, or is taped shut. • Tie up bags once they are ½ to ¾ full and leave on the side of the road for pickup. • Leave all political signs alone
  13. Leave This Blank:

  14. This field is not part of the form submission.