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Pitch-in Registration Form

Thank you for your interest in participating in Pitch-in Week in Severn, happening from April 21 to 27.

Please complete this form if you'd like to register a clean-up.

After completing this form, you can pick up your Pitch-in package at our Administration Office (1024 Hurlwood Lane) Monday through Friday between the hours of 8:30 a.m. to 4:30 p.m.

Please note, we will only pick-up yellow Pitch-in bags that were supplied to you from the Township. Please place your bags safely back from the travelled portion of the road for pick up on Monday, April 28.

If you need further details, please email our Customer Care Team.

Name

If you are registering on behalf of an organization or business, please enter the name of the organization

Street address or closest intersection of your cleanup

Total number of volunteers

Location of bag pickup on Monday, April 28

Phone number

Total number of pairs of gloves requested

Total number of Pitch-in bags requested

Pitch-in packages will be available for pick up after submitting your form. If you' d like to pick-up your package on a specific date, please enter that here:

Privacy statement

Information contained on this form is collected under the authority of the Municipal Act. Information collected will be used and managed by the Township of Severn in accordance with the Municipal Freedom of Information and Protection of Privacy Act for general municipal operations. If you require additional information, please view our Freedom of Information and Routine Disclosure Policy.

Please indicate that you've read and understand the above privacy statement

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Name

Current date

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Pitch-in Registration Form

Privacy statement