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3. GIVE US 5, CAMPBELL - TAKE THE PLEDGE FOR A GREENER, CLEANER COUNTY!
   In tandem with our Keep Campbell County Beautiful awareness campaign, we are inviting our citizens to 'Give Us 5' - five feet, five minutes for five days - to help clean up areas near their homes or areas they frequent. Our wish is that resident volunteers will be safe, but recognize their ability to lead the effort to tackle the trash that has littered our beautiful landscapes and scenic byways.
5. NAME*
6. GROUP NAME (IF APPLICABLE)
8. ADDRESS*
10. CITY*
11. STATE*
12. ZIP CODE*
14. PHONE*
15. EMAIL ADDRESS*
19. MEDIA RELEASE*

    I hereby grant permission to use my likeness in any and all of publications, including website entries, without payment or any other consideration. I understand and agree that these materials are the property of Campbell County and will not be returned. I hereby authorize Campbell County to edit, alter, copy, exhibit, or publish this photo for purposes of marketing programs and events. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Campbell County respects the privacy of all its program participants, and will not release the name of any participant. All measures will be taken to maintain security of all program participant identities. My digital acceptance of this form indicates that I have read this release and I fully understand the contents, meaning, and impact of this release

    1. I have read the above release and agree.
23. RELEASE*

    In consideration of the permission granted to me and/or my group by the County of Campbell, Virginia, to participate in this program, I hereby release and save harmless the County of Campbell, its officers and employees, from all actions, causes of action, damages, claims, or demands which I, my children, my heirs, executors, administrators, or assigns may have against the County of Campbell, and other described parties for all personal and property injuries known or unknown which may have incurred by participating in this activity. I, the undersigned, have read this release and understand all its terms. I execute it voluntarily and with full knowledge of its significance.

    1. I have read the above release and agree.
27. 
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29. 1. Receive an email copy of this form.
30. Email address

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31. Submit

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