Revised 8/5/10 Forms A. Canvassing the Neighborhood B. Clean Neighborhoods Pledge C. Cleanup Timeline Planner D. Cleanup Workday Agenda Model E. Cleanup/Beautification Request F. Getting the Word Out Worksheet G. Good Neighbors Day & Information Drop Timeline H. Litter & Graffiti Citizen Patrols Timeline I. Major Landscaping Project Planner J. Neighborhood Spotter Checklist K. Neighborhood Volunteers L. Planning Session Flyer M. Property Survey N. Request Packet Instructions O. Roll-Off Trash Container Request P. Safety Tips Q. Site Box Score Form R. Supervising Volunteers S. Supply Request T. Volunteer Registration U. Volunteer Waiver V. Warehouse Instructions W. Windshield Survey Main Menu
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Revised 8/5/10
Forms
A. Canvassing the Neighborhood
B. Clean Neighborhoods Pledge
C. Cleanup Timeline Planner
D. Cleanup Workday Agenda Model
E. Cleanup/Beautification Request
F. Getting the Word Out Worksheet
G. Good Neighbors Day & Information Drop Timeline
H. Litter & Graffiti Citizen Patrols Timeline
I. Major Landscaping Project Planner
J. Neighborhood Spotter Checklist
K. Neighborhood Volunteers
L. Planning Session Flyer
M. Property Survey
N. Request Packet Instructions
O. Roll-Off Trash Container Request
P. Safety Tips
Q. Site Box Score Form
R. Supervising Volunteers
S. Supply Request
T. Volunteer Registration
U. Volunteer Waiver
V. Warehouse Instructions
W. Windshield Survey
Main Menu
Revised 8/5/10
Canvassing the Neighborhood
Block
Cross streets
Block captain Phone
Block captain’s address
Contacting your neighbors.
Check all that you plan to do:
A. Call on phone D. Speak to community groups
B. Go door-to-door E. Write letter
C. Post Clean Neighborhoods materials F. Other _________________
Talking to your neighbors.
The success of your neighborhood beautification program depends on getting the
word out to your neighbors. Speaking in person with each resident on your block is
the best way to communicate your enthusiasm. If you have trouble reaching people
at home, try locating their telephone numbers and calling them. As a last resort,
hang flyers on their doorknobs.
When you’re able to reach your neighbors and find they are willing to participate,
include their names, addresses and telephone numbers on the ―Neighborhood
Volunteers‖ form.
Revised 8/5/10
Neighborhood Volunteers
Name Address Phone
Revised 8/5/10
Getting the Word Out Worksheet
Person responsible for communications Phone
Address
Recruitment methods.
Check all that you plan to use:
A. Civic club newsletter H. Photography
B. Door-to-door campaign I. Posters
C. Flyers J. Presentations
D. Local service organizations K. Press release
E. Mail notices L. Site signs
F. News story M. Telephone
G. Newspaper calendar N. Word of mouth
Five key questions.
What points will be emphasized in communications?
Which community newspapers, radio and television programs are your targets?
Revised 8/5/10
Who will be your official photographer to take ―before‖, ―during‖ and ―after‖
shots of all projects?
Who will collect published news stories, correspondence and pictures?
Who will prepare a file of accomplishments to submit to the Mayor’s Proud
Partners Award Program?
Revised 8/5/10
Planning Session Flyer
Help keep our neighborhood beautiful! You can make a difference. You can play an important part in improving our
neighborhood. We need your help to implement the City of Houston and Keep
Houston Beautiful’s Clean Neighborhoods program, an ongoing community
cleanup and landscaping initiative.
If you can imagine a neighborhood free of litter and debris...no more abandoned
cars, overgrown lots or other unsightly nuisances...esplanades lined with flowers,
trees and shrubs...a safer, more prosperous place to work and live...then you can
see what a difference the Clean Neighborhoods program can make to the
appearance of our community.
Help us make our neighborhood a showplace. Join us for our first neighborhood
planning session.
Date Time
Location
Organization
Revised 8/5/10
Safety Tips
As we work to clean up our neighborhood, we should all exercise caution so that
we can prevent this day from being marred by any injury.
The following is a list of Safety Tips that will help us make this day a great
success for all:
1. Watch out for traffic.
2. Be on the watch for snakes around logs, tall grass and other likely places.
3. Under no circumstances should you attempt to pick up syringes or
hypodermic needles!
4. Avoid contact with poison ivy and/or poison oak.
5. Be alert to stinging insects, especially fire ants.
6. Do not attempt to compact (squeeze) trash sacks to gain room for more trash.
Injuries from broken glass or jagged objects often occur as a result of this
practice. Fill the sack with what goes in easily and then get another bag—
we have plenty to go around!
7. Be careful to recognize your own physical limitations.
8. Your block captain has a First Aid Kit should aid be necessary.
Special notes.
Please put aluminum cans into separate bags so that they can be recycled and used
again for something else. Also, see your block captain for specific instructions on
the handling of tires at your site.
Revised 8/5/10
Cleanup Workday Agenda Model Activity Materials
8:00 a.m. Block captains arrive 1 small table with chair
Waste haulers arrive Morning refreshments
Containers placed
Registration area/table setup
8:15 a.m. Final crew assignment made Signs/posters
Signs placed in areas targeted for work
8:30 a.m. Volunteers begin arriving Waiver forms
Register Volunteers (Waivers) Name tags
Assign to crews
Issue name tags/T-Shirts
8:50 a.m. Group begins to rally Trash bags
Block captains welcome and give pep talk Other tools
Place crews together
Distribute equipment bags
9:00 a.m. Crews leave for work site
Work begins
9:15 a.m. Bagged litter placed curbside Beverages
Loaders load truck First aid supplies
Trucks transport bagged litter Bags
Party arrangements begin (hospitality crew)
Noon Volunteers begin returning
Volunteers and equipment checked in
12:30 p.m. All volunteers returned
Wrap-up by block captains
Party begins Food and beverages
1:00 p.m. Volunteers begin leaving
Cleanup crew cleans site
Block captains report to headquarters
Block captains report any heavy trash
Revised 8/5/10
Cleanup Timeline Planner Time Activity
__________ Waste containers placed at collection sites day before cleanup.
__________ Block captains arrive at headquarters site.
__________ Set up registration area.
__________ Set out Clean Neighborhoods site signs.
__________ Volunteers arrive.
__________ Register volunteers, issue T-shirts and sign waiver.
__________ Issue crew assignments.
__________ Distribute equipment.
__________ Volunteer orientation, pep talk and safety tips review.
__________ Cleanup begins.
__________ Trucks transport bagged litter to collection sites.
__________ Roving team with water and extra supplies leaves.
__________ Preparations for lunch begin.
__________ Break for lunch.
__________ Resume cleaning if necessary.
__________ Crews report any remaining heavy trash.
__________ Return tools.
__________ Closing.
__________ Other.
Revised 8/5/10
KEEP HOUSTON BEAUTIFUL
NEIGHBORHOOD CLEANUP VOLUNTEER PROGRAM VOLUNTEER REGISTRATION
Name Organization
Address
City Zip
Home phone Work phone E-mail
ACKNOWLEDGMENT, WAIVER AND RELEASE
This form must be signed by each volunteer who will participate (Participant) in or otherwise be involved with the Keep
Houston Beautiful Neighborhood Cleanup Volunteer Program (Program). Volunteers under age 18 must have this form
signed by a parent of legal guardian.
I ACKNOWLEDGE and UNDERSTAND that I am volunteering my services to the Program gratuitously, without any express
of implied promise by the City to compensate me for my services, and I ACKNOWLEDGE and UNDERSTAND that I am not
entitled to, and will not receive, remuneration of any kind, including, but not limited to, salary or reimbursement for my
transportation, parking, travel, or any other expenses whatsoever which may be incidental to my services as a volunteer for the
Program.
I ACKNOWLEDGE and UNDERSTAND that I will be participating in the Program at my own risk. I affirm that I am
physically fit and prepared to perform services in the Program. I will not create an unsafe situation for other individuals, or
myself, nor will I use any tool or engage in any task with which I am not completely comfortable. I will abide by all applicable
federal, state and local laws, as well as the rules and directions of the Program coordinators. If I see any situation that I feel is
unsafe, I will call it to the attention of a safety coordinator.
IN CONSIDERATION OF PARTICIPANT BEING PERMITTED TO PARTICIPATE AND AS A CONDITION TO
BEING ALLOWED TO PARTICIPATE IN THE PROGRAM, I, THE UNDERSIGNED, FOR AND ON BEHALF OF
MYSELF, MY MINOR CHILD (IF APPLICABLE), MY HEIRS, EXECUTORS, ADMINISTRATORS AND ASSIGNS,
HEREBY RELEASE, ACQUIT AND FOREVER DISCHARGE KEEP HOUSTON BEAUTIFUL, AND THE CITY OF
HOUSTON, TEXAS, TOGETHER WITH ITS/THEIR FORMER AND PRESENT ELECTED AND APPOINTED
OFFICIALS, DIRECTORS, LEGAL REPRESENTATIVES, AGENTS, SERVANTS, EMPLOYEES (IN BOTH THEIR
PUBLIC AND PRIVATE CAPACITIES), VOLUNTEERS, SUCCESSORS, ASSIGNS, AND ALL AFFILIATED
PERSONS AND ENTITIES (HEREINAFTER COLLECTIVELY CITY), OF, FROM AND AGAINST ANY AND ALL
LIABILITIES OF EVERY KIND, CLAIMS, CAUSES OF ACTION, WHETHER AT LAW OR IN EQUITY, IN
CONTRACT OR TORT, UNDER STATUTORY OR COMMON LAW OR PURSUANT TO THE TEXAS OR UNITED
STATES CONSTITUTION(S) (INCLUDING ALL EXPENSES OF LITIGATION, COSTS, AND ATTORNEYS’ FEES),
KNOWN AND UNKNOWN, LOSSES, JUDGMENTS, FINES, DEMANDS, DAMAGES, LOSS OF USE OR SERVICES,
OR INJURIES TO REAL AND/OR PERSONAL PROPERTY AND/OR PERSONS (INCLUDING DEATH)
(COLLECTIVELY CLAIMS), CAUSED BY, ARISING OUT OF, TOUCHING UPON OR IN ANY WAY RELATING
TO THE PROGRAM AND/OR THE PRESENCE, MALFUNCTION, MAINTENANCE, ADDITION, SUBSTITUTION,
USE OR CONDITION OF ANY TANGIBLE PERSONAL OR REAL PROPERTY OWNED, LEASED, OPERATED,
OR UTILIZED BY THE CITY IN CONNECTION WITH THE PROGRAM EVEN IF THE CLAIM IS THE RESULT OF
THE ACTUAL OR ALLEGED SOLE NEGLIGENCE OF THE CITY AND/OR THE RESULT OF THE ACTUAL OR
ALLEGED GROSS NEGLIGENCE OF THE CITY, AND/OR THE ACTUAL OR ALLEGED JOINT OR
CONCURRENT NEGLIGENCE OF THE CITY AND ANY OTHER PERSON OR ENTITY, AND/OR THE ACTUAL
OR ALLEGED STRICT, STATUTORY OR CONSTITUTIONAL LIABILITY OF THE CITY.
Finally, I hereby grant the City full and complete permission to use in legitimate promotions of the Program photographs, video
shots and quotations from me. THANK YOU FOR VOLUNTEERING!
Signature of Participant/Parent or Legal Guardian of Participant Printed Name of Participant Date
Revised 8/5/10
Printed Name of Parent or Legal Guardian (if signing on behalf of a Participant under age 18)
Supervising Volunteers Supervision tips.
Basic tenets of successful volunteer supervision are:
communicating well
expressing appreciation for work
When volunteers are asked to accept assignments, it’s important to fully explain:
Location Condition To note problems, use numbers from your Neighborhood Spotter Checklist. 1. Address Priority Quantity of Trash Type of Trash List Problem Nos.
� High � Heavy � Litter
Cross Street � Medium � Medium � Rubbish Describe “Other” � Low � Light � Heavy trash 2. Address Priority Quantity of Trash Type of Trash List Problem Nos.
� High � Heavy � Litter
Cross Street � Medium � Medium � Rubbish Describe “Other” � Low � Light � Heavy trash 3. Address Priority Quantity of Trash Type of Trash List Problem Nos.
� High � Heavy � Litter
Cross Street � Medium � Medium � Rubbish Describe “Other”
� Low � Light � Heavy trash 4. Address Priority Quantity of Trash Type of Trash List Problem Nos.
� High � Heavy � Litter
Cross Street � Medium � Medium � Rubbish Describe “Other” � Low � Light � Heavy trash 5. Address Priority Quantity of Trash Type of Trash List Problem Nos.
� High � Heavy � Litter
Cross Street � Medium � Medium � Rubbish Describe “Other” � Low � Light � Heavy trash 6. Address Priority Quantity of Trash Type of Trash List Problem Nos.
� High � Heavy � Litter
Cross Street � Medium � Medium � Rubbish Describe “Other”
� Low � Light � Heavy trash 7. Address Priority Quantity of Trash Type of Trash List Problem Nos.
� High � Heavy � Litter
Cross Street � Medium � Medium � Rubbish Describe “Other” � Low � Light � Heavy trash 8. Address Priority Quantity of Trash Type of Trash List Problem Nos.
� High � Heavy � Litter
Cross Street � Medium � Medium � Rubbish Describe “Other”
� Low � Light � Heavy trash 9. Address Priority Quantity of Trash Type of Trash List Problem Nos.
� High � Heavy � Litter
Cross Street � Medium � Medium � Rubbish Describe “Other” � Low � Light � Heavy trash 10. Address Priority Quantity of Trash Type of Trash List Problem Nos.
� High � Heavy � Litter
Cross Street � Medium � Medium � Rubbish Describe “Other”
� Low � Light � Heavy trash AREA OF CITY SPOTTER NAME SIGNATURE DATE
Revised 8/5/10
Cleanup/Beautification Request
Organization Council district Community name Date of request
Contact person Work phone Home phone Mobile phone or pager
Time of event. (Minimum four weeks notice required.)
1st choice for date of event 2nd choice for date of event
Kick-off location/ address Kick-off time
Geographic location.
Key Map page(s) Zip codes
Northern street boundary Southern street boundary
Eastern street boundary Western street boundary
Activities planned.
Check all that you plan to do:
A. Delitter D. Plant trees, shrubs and/or flowers C. Other __________________
Please estimate.
______ # of probationers requested ______ # of volunteers recruited