Please complete the following information about your project. All required fields marked (required). Contact Information Name of group (required) Registrant first name (required) Last name (required) Postal code (required) E-mail (required) Confirm e-mail (required) Phone (required) Extension I consent to the disclosure of my name and contact information to my Ward Councillor for recognition purposes (required) Yes No I participated in the past (required) Yes No How many times have you taken part in Spring or Fall Cleaning the Capital? Please specify. Project Information Location name or address of project site: (required) Location not appearing? Mouse users: click to drop a pin at your desired location. Keyboard users: use +/- to zoom, arrow keys to pan the map, 'z' to drop the pin. Project date (required) MonthSepOct Month Day12345678910111213141516171819202122232425262728293031 Day Year2021 Year From (required) - Select -6:00 AM6:30 AM7:00 AM7:30 AM8:00 AM8:30 AM9:00 AM9:30 AM10:00 AM10:30 AM11:00 AM11:30 AM12:00 PM12:30 PM1:00 PM1:30 PM2:00 PM2:30 PM3:00 PM3:30 PM4:00 PM4:30 PM5:00 PM5:30 PM6:00 PM6:30 PM7:00 PM7:30 PM8:00 PM8:30 PM9:00 PM9:30 PM10:00 PM To (required) - Select -6:00 AM6:30 AM7:00 AM7:30 AM8:00 AM8:30 AM9:00 AM9:30 AM10:00 AM10:30 AM11:00 AM11:30 AM12:00 PM12:30 PM1:00 PM1:30 PM2:00 PM2:30 PM3:00 PM3:30 PM4:00 PM4:30 PM5:00 PM5:30 PM6:00 PM6:30 PM7:00 PM7:30 PM8:00 PM8:30 PM9:00 PM9:30 PM10:00 PM Rain date (required) MonthSepOct Month Day12345678910111213141516171819202122232425262728293031 Day Year2021 Year From (required) - Select -6:00 AM6:30 AM7:00 AM7:30 AM8:00 AM8:30 AM9:00 AM9:30 AM10:00 AM10:30 AM11:00 AM11:30 AM12:00 PM12:30 PM1:00 PM1:30 PM2:00 PM2:30 PM3:00 PM3:30 PM4:00 PM4:30 PM5:00 PM5:30 PM6:00 PM6:30 PM7:00 PM7:30 PM8:00 PM8:30 PM9:00 PM9:30 PM10:00 PM To (required) - Select -6:00 AM6:30 AM7:00 AM7:30 AM8:00 AM8:30 AM9:00 AM9:30 AM10:00 AM10:30 AM11:00 AM11:30 AM12:00 PM12:30 PM1:00 PM1:30 PM2:00 PM2:30 PM3:00 PM3:30 PM4:00 PM4:30 PM5:00 PM5:30 PM6:00 PM6:30 PM7:00 PM7:30 PM8:00 PM8:30 PM9:00 PM9:30 PM10:00 PM Number of participants (required) - Select -12345678910111213141516171819202122232425 Participant category (required) - Select -Adopt-a-park/Roadway programBusiness corporationCommunity agency/OrganizationDay Care/MontessoriFamily/FriendsGovernmentIndividualNeighbourhood/Recreation community associationNeighboursSchool - ElementarySchool - High schoolSchool - Post secondaryReligious OrganizationService clubTenant Association/BoardYouth group (ie. Scouts) Type of project (required) Litter cleanup Shoreline/water way clean up What is your adopted area? Litter Cleanup Starter Kits Starter kits are designed to provide you with enough supplies to get you started on your project. Kits are individually packed for each project team based on the number of volunteers you have registered. Supplies have been provided by our generous sponsors and are in limited quantity. Litter cleanup kits include vinyl gloves, garbage bags and leaf and yard waste bags. YOUR STARTER KIT WILL TAKE UP TO 9 BUSINESS DAYS TO ARRIVE AT YOUR CHOSEN PICK UP LOCATION. YOU MAY NOT RECEIVE A CALL WHEN IT GETS THERE. WE RECOMMEND YOU CALL BEFORE TO ENSURE IT IS THERE IF YOU REQUIRE YOUR KIT SOONER PLEASE CONTACT US AT 613-580-2400, extension 13458 Do you require a litter cleanup starter kit? (required) Yes No Starter kit contents Disposable gloves Garbage bags Choose glove size Small Medium Large Specific kit requirements Graffiti Removal Starter Kit Graffiti removal kits are intended for use on public assets only. They include graffiti removal wipes (effective on smooth surfaces only), masks and gloves. Do you require a graffiti removal starter kit? (required) Yes No Starter Kit pick-up location (required) IMPORTANT Please allow at least 9 days from registration before Starter Kit pickup. View map and hours of operation. Please note locations that require to book a time to pick up cleanup kit. Ben Franklin Place Client Service Centre, 101 Centrepointe Drive Bob MacQuarrie recreation complex, 1490 Youville Drive City Hall Client Service Centre, 110 Laurier Avenue West CardelRec recreation complex), 1500 Shea Road Overbrook Community Centre, 33 Quill Street Richcraft recreation complex, 4101 Innovation Drive Sandy Hill Community Centre, 250 Somerset Street East Comments How did you find out about Cleaning the Capital Program? Select all that apply. Community outreach Community/councillor newsletter Community association Special event Word-of-mouth Newspaper ads Le Droit Ottawa Citizen Ottawa Sun Community newspaper Online ottawa.ca Direct e-mail Google ads Facebook ads Physical ads/posters Community poster City facility posters School posters OC Transpo ads Disclaimer (required) I accept: By registering as a participant of this program you and your group agrees to indemnify and save harmless the City of Ottawa from any and all claims, demands, causes of action, loss, costs or damages that the City of Ottawa may suffer, incur or be liable for, resulting from you and your groups performance under this program, save and except damages, claims, demands, actions or causes of action arising out of or as a result of the actions of the City of Ottawa. Personal information collected on this form is for the proper administration of the Civic Pride Program, as approved by City Council on February 16, 1994 and established pursuant to subsection 10(1) of the Municipal Act, 2001 S.O. 2001, Chapter 25, and will only be used for registration, planning, and tracking participants in the Cleaning the Capital campaign. Questions regarding the collection of this information may be addressed to: Cleaning the Capital Program, Public Outreach and Communications, Public Works and Environmental Services Department at 613-580-2424, ext. 13458 (TTY: 613-580-2401). Please note: If your registration is successful, a confirmation screen including your registration code will appear immediately after pressing the "Submit" button. You will receive an email shortly after. If your registration is not successful, please read the error messages and correct your registration form accordingly and press "Submit". If you are unable to successfully complete your registration, please call 3-1-1 for assistance. Submit
