Cora Island M:CS Registration

If you would like to volunteer to participate in the Mission: Clean Stream clean up at Cora Island, please complete the registration below. 

Thank you so much for your participation.

Please click on this WAIVER RELEASE FORM to open it in your browser.  Then please print and complete it.  Each participant must have a completed waiver.  Bring it with you to the event. This will save a lot of time.  Thanks for your participation!

* First Name
* Last Name
* Address 1:
Address 2:
* City :
* State :
* Zip :
* Email :
* Phone : ( ) -
* Age :  18 Yrs. or Older
  Less than 18 Yrs
* Emergency Contact Name :
* Emergency Contact Number : ( ) -
* Did you download and print the waiver form?  Yes
  No
Family Member 1 Name :
Family Member 1 Age :  18 Yrs. or Older
  Less than 18 Yrs
Family Member 2 Name :
Family Member 2 Age :  18 Yrs. or Older
  Less than 18 Yrs
Family Member 3 Name :
Family Member 3 Age :  18 Yrs. or Older
  Less than 18 Yrs
Family Member 4 Name :
Family Member 4 Age :  18 Yrs. or Older
  Less than 18 Yrs
Family Member 5 Name :
Family Member 5 Age :  18 Yrs. or Older
  Less than 18 Yrs
I am a member of a group (not a family)  Yes
  No
Name of My Group
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