Highway Cleanup Registration
Put your service into action during a highway clean up, hosted by Beta Rho Zeta - NTC's chapter of Phi Theta Kappa. We'll clear litter/debris from a stretch of road along highway K - going right past the Agriculture Center of Excellence (NTC Farm).

All volunteers will meet at the NTC Farm to receive instruction, don safety vests and gloves, and obtain garbage bags. While participants will likely have safety vests, everyone is encouraged to wear brightly colored clothes. You will likely also appreciate boots and possibly layered clothing, depending on the day's forecast.

To help us plan, please register by 5:00 p.m. on Wednesday, September 29.

Note: If you're a member of a NTC student club, you may be able to earn $20 Community Service attendance bonus for your club by participating! Must participate at least 60 minutes for credit.

Event Details
* * * * * * * * * * * *
Friday, October 1, 2021
Begin at NTC Farm
Flexible start times: 9:00 a.m.-12:00 p.m.

Sign in to Google to save your progress. Learn more
Email *
First Name *
Last Name *
Confirm NTC student/employee email. *
NTC Program (or Department) *
Student Club (if applicable)
What time(s) do you plan to assist? *
Required
Emergency Contact Details
In the event of an emergency at the event, please advise who to contact on your behalf.
Emergency Contact Name (first and last) *
Emergency Contact Phone Number (including area code) *
Emergency Contact Relationship (parent, spouse, friend, etc.) *
Assumption of Risk and Release of Liability
Whereas, I desire to participate in the highway cleanup - sponsored by Northcentral Technical College Student Life and Beta Rho Zeta (hereafter referred to as “the College”) has approved my participation, I hereby agree as follows:

1) I assume full legal and financial responsibility for my participation in this event;

2) I grant the College, their employees, agents and representatives the authority to act in any attempt to safeguard and preserve my health or safety during my participation in the high risk activity including authorizing medical treatment on my behalf and at my expense and returning me home at my own expense for medical treatment or in case of an emergency;

3) I shall conform to all applicable policies, rules, regulations, and standards of conduct as established by the College to ensure the best interest, comfort and welfare of the activity;

4) I shall accept termination of my participation in the activity by the College if I fail to maintain acceptable standards of conduct as established by the College;

5) The College reserves the right to make changes to the program at any time and for any reason, with or without notice, and the College shall not be liable for any loss whatsoever to program participants as a result of such changes;

6) I voluntarily indemnify and hold harmless the College, Board of Trustees, the Wisconsin Technical College System, their respective officers, employees, and agents from any and all liability, loss, damages, costs, or expenses (including attorney’s fees) arising out of my participation in the risk activity and which do not arise out of the negligent acts or omission of an employee, and agent of the College and/or WTCS while acting within the scope of their employment or agency.

7) I agree photographs, pictures, slides, movies, video, or other media coverage of myself may be taken in connection with my participation in the activity, without compensation from Northcentral Technical College, the Board of Trustees or its affiliates, its auxiliary organizations, employees, volunteers, and agents of each of them (hereinafter referred to as the “Director of Student Development/Student Life Team) and consent to the use of photographs, pictures, slides, movies, videos, and other media coverage for any legal purpose.
By selecting "I agree," you acknowledge you have read the Assumption of Risk and Release of Liability statement and understand and accept its terms. *
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy