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Citywide Cleanup Registration Form

  1. Citywide Cleanup Registration Form

  2. Use this form to register for the Port Arthur Citywide Cleanup! Please use one form per person.

  3. This event will be held every Saturday in February, beginning February 6, 2021, from 8:00 AM until 11:00 AM. Please join us!

  4. Contact Information


    This form MUST be completed for all registrants. Parents/Guardians must sign for participants 17 years of age, or younger.

  6. I hereby agree to release the City of Port Arthur staff, it instructors, or any person(s) appointed from the responsibility for any injuries or accidents which my child may incur while participating in any of the activities offered by the City of Port Arthur. I also understand that if my child has any special needs, I will inform the appropriate staff in writing to be accessed in case of an emergency. AND, I further agree to allow The City of Port Arthur and any news media to use any photos, or videos of my child that may be taken during his/her participation in the City Wide Clean Up.

  7. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  8. Leave This Blank:

  9. This field is not part of the form submission.