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Required fields are marked with an asterisk (*). One of the fields below is a file upload/attachment, the file size must be less than 10MB.
Have you volunteered with Earth Day Trash Bash before? *
Birthdate *
A valid date as MM/DD/YYYY (for example: 11/30/2015)
Together, we grow meaningful community connections that celebrate our diversity, cultivate inclusivity, and inspire shared passion and purpose for enriching Des Moines’ quality of life.
We welcome volunteers of all abilities. If you require specific accommodations to participate, we encourage you to let us know in advance. We will do our best to provide reasonable accommodations to make your experience with us comfortable and rewarding.
Do you have any access requirements or accommodation requests you'd like us to be aware of? *
Please feel free to list any accommodations or allergies below. If you would like to discuss your specific needs, please contact Parks and Recreation Supervisor, Callie Le’au Courtright at chlcourtright@dmgov.org or call 515-505-2231.
First Name *
Last Name *
Cell Phone *
For example, 123-456-7890
Other Phone (Work, Home):
Address *
City *
Zip Code *
Company/Organization
Are you a Group Leader organizing a group/team for Earth Day Trash Bash? *
Does the group/team you are organizing have 5 or more people on it? *
Please list shirt size. *
Are you leading a litter clean-up (self-led)? *
Please select the date you would like to pick up your supplies. *
Thank you for organizing and leading a team for Iowa's largest Earth Day volunteer event, Earth Day Trash Bash. You have two options as a team leader.
1. Share the link and have them register themselves in the available openings. Please be aware registrations are first-come/first-served. When an event is full it will automatically close online.
2. OR, contact us at trashbash@dmgov.org for a password-protected shift and link to share with your team. This option holds the available openings left and your team is registered together. Each person on your team will need to register themselves individually with this link to accept the waiver. Each person will receive their own confirmation. Please note the spots will only be held until 2 weeks prior to the event. If your team does not complete their registration process, the spots will be opened for other volunteers to fill them.
We look forward to working with your team! If you have any questions, contact us at trashbash@dmgov.org or call (515)505-2231.
Shirt Size: *
Are you 18 years or older? *
Parent/Legal Guardian Full Name *
Parent/Legal Guardian Cell Phone *
I understand that the City of Des Moines Parks and Recreation does not discriminate on the basis of race, color, national origin, gender, disability, religion, creed, age, familial status, sexual orientation, gender identity, and ancestry in its programs and its employment practices.
I understand that submitting this information does not guarantee my, or my minor child's, acceptance as a volunteer, and that assignment of volunteer work is based on the assessments made by the volunteer coordinator, Director, and staff.
I understand that if I have misrepresented any information and/or fail to adhere to volunteer guidelines, I, or my minor child, may have our application approval withdrawn.
I assume full responsibility for my, or my minor child's, actions and authorize the staff at the site I, or my minor child, am volunteering to act on my behalf in the event of an emergency.
I understand that the City of Des Moines Parks and Recreation does not discriminate on the basis of race, color, national origin, gender, disability, religion, creed, age, familial status, sexual orientation, gender identity, and ancestry in its programs and its employment practices.
I understand that submitting this information does not guarantee my acceptance as a volunteer, and that assignment of
volunteer work is based on the assessments made by the volunteer coordinator, Director, and staff.
I understand that if I have misrepresented any information and/or fail to adhere to volunteer guidelines, I may have my
application approval is withdrawn.
I assume full responsibility for my actions and authorize the staff at the site I am volunteering to act on my behalf in the
event of an emergency.
Emergency Contact Full Name *
Emergency Contact Cell Phone *
I understand the above and hereby certify that all statements made and information submitted applicable to volunteering with the City of Des Moines, Iowa are true and contain no misrepresentation. *
Do you accept and agree to the attached Permission to Participate, Release and Waiver of Liability, Assumption of Risk and Indemnity Agreement and Photo Release? *
Waiver
*This waiver is listed at https://www.dsm.city/departments/parks_and_recreation-division/partners/volunteers.php which. To view in a different language visit the website and select EN at the top right.
In consideration of me, or my minor child, being permitted to participate in any way in the above-named Volunteer Program, I, the Undersigned, for myself and my minor child, all of my or my minor child's, personal representatives, executors, administrators, heirs, next of kin, successors and assigns, herein referred to as "Releasors", do hereby:
1. Acknowledge that this volunteer service carries with it the potential for serious injury, death and/or property damage, and certify as to my physical fitness and that of my minor child to participate and declare that neither I, nor my minor child, have been advised otherwise by a qualified medical professional.
2. Acknowledge, agree, and represent that I and my minor child will, at all times, be aware of the surroundings during the volunteer service and agree that if I or my minor child consider anything related to this Activity to be unsafe, will immediately advise the Activity officials of such, and if necessary, will leave the area or refuse to participate further in the volunteer service.
3. Waive, release and discharge, and covenant not to sue, the City of Des Moines, Iowa, its elected and appointed officials, employees, volunteers, sponsors, partner organizations and agents, including others who give recommendations, directions, or instructions as part of this volunteer service, hereinafter referred to in this document as "City", from any and all liability to Releasors, except for my minor child, for any and all loss or damage, and any claim or demands therefore, on account of injury to the person or property, or resulting in my death or that of my minor child, including but not limited to illness or damage to me or my minor child’s property arising out of or related to the volunteer service, including traveling to or from the volunteer service and before, during, and after the volunteer service.
4. Agree to Indemnify and Save and Hold Harmless the City and each of them from any loss, liability, damage, or cost to third parties that they may incur arising out of or related to me or my minor child’s participation in this volunteer service.
5. Assume full responsibility for any risk of bodily injury, including but not limited to illness, death or property damage arising out of or related to the volunteer service. I agree to comply with all applicable safety rules, including wearing protective clothing, close-toed shoes/boots, safety goggles, gloves, and vest while performing my volunteer activities.
6. Agree that this Permission to Participate, Release and Waiver of Liability, Assumption of Risk, and Indemnity Agreement and Photo Release extends to all acts of negligence by the City, but excluding willful, wanton or reckless conduct, and is intended to be as broad and inclusive as is permitted by law including any governmental immunity afforded the City by law and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.
7. Authorize any medical treatment, including the administration of anesthesia, deemed advisable by any licensed physician and/or Emergency Responder (EMT) to relieve any injuries received or illness contracted by me or my minor child as a participant in this volunteer service. I hereby agree to pay all costs of any medical treatment or emergency transportation.
8. Authorize and consent to the City, its sponsors, and any news media, and their successors and assigns and those acting under their authority, to take, publish, use for public display in any media now or hereinafter known and including without limitation on the City’s social media accounts, and copyright photographs, videotape or other audio or visual media, including broadcast in any media, of me or my minor child, including but not limited to those that capture me or my minor child’s name, voice, and/or image, and agree that such may be used for any lawful purpose without limitation or reservation and without further compensation or approval.
I have read the Permission to Participate, Release and Waiver, Assumption of Risk and Indemnity Agreement and Photo Release, fully understand its terms, understand that I have given up substantial rights of my own and of my minor child by signing it, and sign it voluntarily without assurance or guarantee being made to me and intend my signature to be a complete and unconditional release of all liability to the fullest extent permitted by law, including all acts of negligence by the City as stated above. I agree that this Permission to Participate, Release and Waiver, Assumption of Risk and Indemnity Agreement and Photo Release will be IN EFFECT for 5 YEARS from the date of my signature and/or electronic submission, unless otherwise terminated by me in writing delivered to the City.
*This waiver is listed at https://www.dsm.city/departments/parks_and_recreation-division/partners/volunteers.php which. To view in a different language visit the website and select EN at the top right.
In consideration of me, or my minor child, being permitted to participate in any way in the above-named Volunteer Program, I, the Undersigned, for myself and my minor child, all of my or my minor child's, personal representatives, executors, administrators, heirs, next of kin, successors and assigns, herein referred to as "Releasors", do hereby:
1. Acknowledge that this volunteer service carries with it the potential for serious injury, death and/or property damage, and certify as to my physical fitness and that of my minor child to participate and declare that neither I, nor my minor child, have been advised otherwise by a qualified medical professional.
2. Acknowledge, agree, and represent that I and my minor child will, at all times, be aware of the surroundings during the volunteer service and agree that if I or my minor child consider anything related to this Activity to be unsafe, will immediately advise the Activity officials of such, and if necessary, will leave the area or refuse to participate further in the volunteer service.
3. Waive, release and discharge, and covenant not to sue, the City of Des Moines, Iowa, its elected and appointed officials, employees, volunteers, sponsors, partner organizations and agents, including others who give recommendations, directions, or instructions as part of this volunteer service, hereinafter referred to in this document as "City", from any and all liability to Releasors, except for my minor child, for any and all loss or damage, and any claim or demands therefore, on account of injury to the person or property, or resulting in my death or that of my minor child, including but not limited to illness or damage to me or my minor child’s property arising out of or related to the volunteer service, including traveling to or from the volunteer service and before, during, and after the volunteer service.
4. Agree to Indemnify and Save and Hold Harmless the City and each of them from any loss, liability, damage, or cost to third parties that they may incur arising out of or related to me or my minor child’s participation in this volunteer service.
5. Assume full responsibility for any risk of bodily injury, including but not limited to illness, death or property damage arising out of or related to the volunteer service. I agree to comply with all applicable safety rules, including wearing protective clothing, close-toed shoes/boots, safety goggles, gloves, and vest while performing my volunteer activities.
6. Agree that this Permission to Participate, Release and Waiver of Liability, Assumption of Risk, and Indemnity Agreement and Photo Release extends to all acts of negligence by the City, but excluding willful, wanton or reckless conduct, and is intended to be as broad and inclusive as is permitted by law including any governmental immunity afforded the City by law and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.
7. Authorize any medical treatment, including the administration of anesthesia, deemed advisable by any licensed physician and/or Emergency Responder (EMT) to relieve any injuries received or illness contracted by me or my minor child as a participant in this volunteer service. I hereby agree to pay all costs of any medical treatment or emergency transportation.
8. Authorize and consent to the City, its sponsors, and any news media, and their successors and assigns and those acting under their authority, to take, publish, use for public display in any media now or hereinafter known and including without limitation on the City’s social media accounts, and copyright photographs, videotape or other audio or visual media, including broadcast in any media, of me or my minor child, including but not limited to those that capture me or my minor child’s name, voice, and/or image, and agree that such may be used for any lawful purpose without limitation or reservation and without further compensation or approval.
I have read the Permission to Participate, Release and Waiver, Assumption of Risk and Indemnity Agreement and Photo Release, fully understand its terms, understand that I have given up substantial rights of my own and of my minor child by signing it, and sign it voluntarily without assurance or guarantee being made to me and intend my signature to be a complete and unconditional release of all liability to the fullest extent permitted by law, including all acts of negligence by the City as stated above. I agree that this Permission to Participate, Release and Waiver, Assumption of Risk and Indemnity Agreement and Photo Release will be IN EFFECT for 5 YEARS from the date of my signature and/or electronic submission, unless otherwise terminated by me in writing delivered to the City.
Check here to show you accept the terms stated above for yourself.
I, the Undersigned, for myself and/or my minor child, have read the Permission to Participate, Release and Waiver, Assumption of Risk and Indemnity Agreement and Photo Release, fully understand its terms, understand that I have given up substantial rights of my own and of my minor child by signing it, and sign it voluntarily without assurance or guarantee being made to me and intend my signature to be a complete and unconditional release of all liability to the fullest extent permitted by law, including all acts of negligence by the City as stated above. I agree that this Permission to Participate, Release and Waiver, Assumption of Risk and Indemnity Agreement and Photo Release will be IN EFFECT for 5 YEARS from the date of my signature and/or electronic submission, unless otherwise terminated by me in writing delivered to the City.
*This waiver is listed at https://www.dsm.city/departments/parks_and_recreation-division/partners/volunteers.php which. To view in a different language visit the website and select EN at the top right.
In consideration of me, or my minor child, being permitted to participate in any way in the above-named Volunteer Program, I, the Undersigned, for myself and my minor child, all of my or my minor child's, personal representatives, executors, administrators, heirs, next of kin, successors and assigns, herein referred to as "Releasors", do hereby:
1. Acknowledge that this volunteer service carries with it the potential for serious injury, death and/or property damage, and certify as to my physical fitness and that of my minor child to participate and declare that neither I, nor my minor child, have been advised otherwise by a qualified medical professional.
2. Acknowledge, agree, and represent that I and my minor child will, at all times, be aware of the surroundings during the volunteer service and agree that if I or my minor child consider anything related to this Activity to be unsafe, will immediately advise the Activity officials of such, and if necessary, will leave the area or refuse to participate further in the volunteer service.
3. Waive, release and discharge, and covenant not to sue, the City of Des Moines, Iowa, its elected and appointed officials, employees, volunteers, sponsors, partner organizations and agents, including others who give recommendations, directions, or instructions as part of this volunteer service, hereinafter referred to in this document as "City", from any and all liability to Releasors, except for my minor child, for any and all loss or damage, and any claim or demands therefore, on account of injury to the person or property, or resulting in my death or that of my minor child, including but not limited to illness or damage to me or my minor child’s property arising out of or related to the volunteer service, including traveling to or from the volunteer service and before, during, and after the volunteer service.
4. Agree to Indemnify and Save and Hold Harmless the City and each of them from any loss, liability, damage, or cost to third parties that they may incur arising out of or related to me or my minor child’s participation in this volunteer service.
5. Assume full responsibility for any risk of bodily injury, including but not limited to illness, death or property damage arising out of or related to the volunteer service. I agree to comply with all applicable safety rules, including wearing protective clothing, close-toed shoes/boots, safety goggles, gloves, and vest while performing my volunteer activities.
6. Agree that this Permission to Participate, Release and Waiver of Liability, Assumption of Risk, and Indemnity Agreement and Photo Release extends to all acts of negligence by the City, but excluding willful, wanton or reckless conduct, and is intended to be as broad and inclusive as is permitted by law including any governmental immunity afforded the City by law and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.
7. Authorize any medical treatment, including the administration of anesthesia, deemed advisable by any licensed physician and/or Emergency Responder (EMT) to relieve any injuries received or illness contracted by me or my minor child as a participant in this volunteer service. I hereby agree to pay all costs of any medical treatment or emergency transportation.
8. Authorize and consent to the City, its sponsors, and any news media, and their successors and assigns and those acting under their authority, to take, publish, use for public display in any media now or hereinafter known and including without limitation on the City’s social media accounts, and copyright photographs, videotape or other audio or visual media, including broadcast in any media, of me or my minor child, including but not limited to those that capture me or my minor child’s name, voice, and/or image, and agree that such may be used for any lawful purpose without limitation or reservation and without further compensation or approval.
I have read the Permission to Participate, Release and Waiver, Assumption of Risk and Indemnity Agreement and Photo Release, fully understand its terms, understand that I have given up substantial rights of my own and of my minor child by signing it, and sign it voluntarily without assurance or guarantee being made to me and intend my signature to be a complete and unconditional release of all liability to the fullest extent permitted by law, including all acts of negligence by the City as stated above. I agree that this Permission to Participate, Release and Waiver, Assumption of Risk and Indemnity Agreement and Photo Release will be IN EFFECT for 5 YEARS from the date of my signature and/or electronic submission, unless otherwise terminated by me in writing delivered to the City.
Check here to show you accept the terms stated above for yourself or for a minor volunteer for which you are a parental guardian.
I, the Undersigned, for myself and/or my minor child, have read the Permission to Participate, Release and Waiver, Assumption of Risk and Indemnity Agreement and Photo Release, fully understand its terms, understand that I have given up substantial rights of my own and of my minor child by signing it, and sign it voluntarily without assurance or guarantee being made to me and intend my signature to be a complete and unconditional release of all liability to the fullest extent permitted by law, including all acts of negligence by the City as stated above. I agree that this Permission to Participate, Release and Waiver, Assumption of Risk and Indemnity Agreement and Photo Release will be IN EFFECT for 5 YEARS from the date of my signature and/or electronic submission, unless otherwise terminated by me in writing delivered to the City.
