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Green Bucket Brigade Registration

  1. Green Bucket Brigade Registration

    Thank you for your interest in the City of Norfolk’s Green Bucket Brigade, an invaluable part of our City’s litter reduction and prevention efforts! Please review the following guidelines for participating in this program. Note, if no green buckets are available, you will be waitlisted and notified when a bucket is returned. **Volunteers must be 18 years or older to adopt a bucket, or must submit parental permission form.**

  2. Who are you requesting a Green Bucket for? *
  3. Please provide the address of your business. 

  4. As a member of the Green Bucket Brigade, I agree to comply with the following requirements by checking each box below: *
  5. Certification and Acknowledgement of Risks
    I hereby certify that all statements made in this application are true and correct to the best of my knowledge, and I authorize investigation of all matters contained in this application or data pertinent to my volunteering. I acknowledge that any false statements or misrepresentation on this application will be cause for refusal of placement or immediate dismissal. I understand and agree that in the performance of voluntary services, I am not a City of Norfolk employee and shall have no rights to wages or benefits and no promise, expressed or implied, of consideration for future employment. I agree to indemnify and hold the City of Norfolk, its employees and contractors harmless from any and all liability for any injury that I might incur arising out of or in any way connected to my participation in this program. I also agree to grant full permission to the City of Norfolk to use my name and any photographs, video or recordings for any purpose whatsoever without many obligation, liability or compensation to me. Volunteers are not covered under the City of Norfolk Worker’s Compensation Plan. Therefore, it is recommended volunteers have their own medical insurance coverage. If a serious incident occurred a legal claim could be presented and an investigation into negligence would take place. For more information refer to the City of Norfolk City, Code Section 2-155, Appendix C and/or contact the Human Resources Department at 757-664-4056.
  6. By signing the above you agree to the conditions of the Green Bucket Brigade, and attest that you are at least 18 years or older.
  7. Leave This Blank:

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