Form Center

2. Thank you for registering for the District 5 Community Clean-Up on Sunday, October 30, 2022. Volunteers must check in at Veterans Memorial Park (entrance on Pacific Ave.) at 7:30 a.m. to pick up gloves, trash bags, tools, and maps of designated clean-up locations. If you have any questions, please contact Devyn Fisher at dfisher@jurupavalley.org or 951-332-6464 ext. 119.
4. First Name*
5. Last Name*
7. Are you at least 18 years old?

   1. Yes
   2. No

   All volunteers must sign a waiver. Volunteers under the age of 18 must have a waiver signed by a parent/guardian PRIOR to check-in. All children must be accompanied by an adult. 

9. Volunteer Waiver
   Complete the volunteer waiver

   Please complete the volunteer waiver and submit it to dfisher@jurupavalley.org or bring it on the day of the event. Waivers will also be available at check-in.

11. Are you RSVPing for others?
    -- Select One --YesNo
13. First and Last Name(s)

    Please include the names of all other volunteers in your group. If any volunteers are under the age of 18, please reach out to dfisher@jurupavalley to complete a waiver PRIOR to the event.

15. Email Address

    Enter your email address to be notified of future volunteer opportunities.

17. How did you hear about this event?

    1. Social Media (Instagram, Facebook, Twitter)
    2. City Website
    3. City Newsletter
    4. School
    5. Community Club/Organization
    6. Other
19. If Other, please specify.
Leave This Blank:


21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit

* indicates a required field