KMB Kids' Clinic

Join us for the KMB Kids' Clinic Summer 2024!

For three days in July, we will have our "Green" day, "Clean" day, and our "Beautification" day.

July 1st, 10-11:30am - Green day
July 2nd, 10-11:30am - Clean day
July 3rd, 10-11:30am - Beautification day

For children ages 7-12yrs old, space is limited to only 10 children.

Please fill out this release for each child you are registering: https://keepmidlandbeautiful.org/forms/volunteer-agreement-liability-release-form

Parent Name:
Parent Phone Number:
Parent Email:
How many children are you registering?
Child(ren) name and age(s):
I understand when placing a t-shirt order, it is one t-shirt per participant.

I understand when placing a t-shirt order, it is one t-shirt per participant. Yes
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
THE RELEASE FORM MUST BE SUBMITTED BEFORE PARTICIPATION IN THE EVENT CAN BE ALLOWED.
In consideration of Keep Midland Beautiful’s acceptance of this entry in the above Project, we, the undersigned, individually and on behalf of our minor child/children, administrators and assigns, forever release and discharge any and all rights, demands, claims and causes of suite or action, known or unknown, whether arising now or in the future that we, individually and our minor child/children may have against Keep Midland Beautiful, its officers, agents, employees, and volunteers, and all other property owners and any other participating sponsors, as the officers, employees and agents of such parties for any and all injuries, including death and property damage, in any manner arising or resulting from participation in said Project. We attest and verify that we have full knowledge of the risks involved in the Project, that we individually assume those risks on behalf of ourselves and our minor children, and that we will individually without limitations, assume and pay any medical and/or emergency expenses in the event of an accident, injury, illness or other incapacity, regardless of whether we have authorized such expenses. Further, we state that we have carefully read this Release, know the contents of the Release, and sign this Release of our own free will.

THE RELEASE FORM MUST BE SUBMITTED BEFORE PARTICIPATION IN THE EVENT CAN BE ALLOWED.
In consideration of Keep Midland Beautiful’s acceptance of this entry in the above Project, we, the undersigned, individually and on behalf of our minor child/children, administrators and assigns, forever release and discharge any and all rights, demands, claims and causes of suite or action, known or unknown, whether arising now or in the future that we, individually and our minor child/children may have against Keep Midland Beautiful, its officers, agents, employees, and volunteers, and all other property owners and any other participating sponsors, as the officers, employees and agents of such parties for any and all injuries, including death and property damage, in any manner arising or resulting from participation in said Project. We attest and verify that we have full knowledge of the risks involved in the Project, that we individually assume those risks on behalf of ourselves and our minor children, and that we will individually without limitations, assume and pay any medical and/or emergency expenses in the event of an accident, injury, illness or other incapacity, regardless of whether we have authorized such expenses. Further, we state that we have carefully read this Release, know the contents of the Release, and sign this Release of our own free will. Yes
I hereby grant the Keep Midland Beautiful, Public and Media Relations Office, the right to photograph members, employees, officers, and/or any agents participating in Keep Midland Beautiful events and to use or authorize the use of the photo for promotional purposes as related to Keep Midland Beautiful produced publications and materials and external publications and materials where Keep Midland Beautiful would release use of the photo to support information about Keep Midland Beautiful programs and services.
I hereby acknowledge that no fee is payable by Keep Midland Beautiful, Public and Media Relations Office, for this appearance or resulting distribution, and that the provisions of this release are legally binding.

I hereby grant the Keep Midland Beautiful, Public and Media Relations Office, the right to photograph members, employees, officers, and/or any agents participating in Keep Midland Beautiful events and to use or authorize the use of the photo for promotional purposes as related to Keep Midland Beautiful produced publications and materials and external publications and materials where Keep Midland Beautiful would release use of the photo to support information about Keep Midland Beautiful programs and services.
I hereby acknowledge that no fee is payable by Keep Midland Beautiful, Public and Media Relations Office, for this appearance or resulting distribution, and that the provisions of this release are legally binding. I agree. I do not agree.
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