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Personal details

First Name (Required)

Surname (Required)

Date of birth (Required)

Address

Address line 1 (Required)

Address line 2 / Ward

Postcode (Required)

Contact details

Your Email address (Required)

Your Phone number

Health conditions

Do you have any health conditions that may be effected when litter picking with us? We may contact you to offer advice and support as part of our risk assessment.
NoYes

[group group-health]
If yes, please provide details (Required)

[/group]

Do you define yourself as disabled?
NoYes

Do you currently have a carer or support worker?
NoYes

Emergency contact details

Name (Required)

Relationship to you (Required)

Phone number (Required)

Litter Heroes

If you are the parent or guardian of any children under the age of 18 you would like to register as Litter Heroes, please fill in the below boxes.

Declaration

Before submitting your application you must agree to the following conditions:

• I declare that the information given on this form is true to the best of my knowledge and belief.

• I agree to:

  • Adhere to the safe working practices outlined in my Litter Champion Handbook/Training.

  • Always use the safe litter picking equipment and Personal Protective equipment supplied in the Litter Champion lockers

  • Be responsible for any children that are litter picking with me.

  • Only pick up litter and report anything else (fly tipping/ hazardous litter). Reporting channels are detailed in the Litter Champion Training/ Handbook

  • Be respectful of other volunteers, members of staff and the general public.

  • Record my litter picks and inform the Love Where You Live team regularly about my activities.

  • Let the Love Where You Live team know as soon as possible of any changes of circumstances.

  • Return the equipment to the hub locker as I would expect to find it and report any damages.

  • Let the Love Where You Live team know if I am unhappy or concerned about anything, or if I wish to stop volunteering.