TRASH 4 CA$H Application and Agreement
*required fields
Group/Team Name
*Non-profit Organization You Are Representing
*Group Main Contact Name
*Group Contact Telephone Number
*Group Main Contact Email
*Group Size (Total Number of Volunteers)
*Preferred Date (Ex. November 1, 2021)
Choose Three (3) Street Clean-up Preferences (See map and tabs above)
Ridgecrest Rd. (Christmasville - N. Highland Ave.)
Old Humboldt Rd./Volunteer Rd. (US Hwy 45 Bypass - N. Highland Ave)
Oil Well Rd./W. University Pkwy. (US Hwy 45 Bypass - N. Highland Ave.)
E. University Pkwy./Cooper Anderson Rd. (N. Highland Ave. - Old Medina)
Old Humboldt Rd. (US Hwy 45 Bypass - Ashport Rd.)
Oil Well Rd./Pipkin Rd. (US Hwy 45 Bypass - Express Dr.)
Pleasant Plains Ex. (Country Club Ln - Oil Well Rd.)
Country Club Ln. (Express Dr. - Pleasant Plains Ext.)
Hollywood Ave. (Airways Blvd. - Russell Rd.)
Russell Rd. (Hollywood Ave. - North Parkway)
Lambuth Blvd. (Airways Blvd. - N. Highland Ave.)
Skyline Drive (N. Highland Ave. - Wallace Rd.)
Chester St. (Shirlene Mercer Park - Hillcrest Cir.)
Royal St. (E. Main St. - N. Parkway)
Lexington Ave. (Royal St. - Dr. F.E. Wright Dr.)
Whitehall St. (Lexington Ave. - Dr. F.E. Wright Dr.)
Highway 18 (S. Highland Ave. - Malesus Park)
Bemis Ln./A. St. (S. Highland Ave. - Tennessee St.)
Missouri St. (Harts Bridge Rd. - D. St.)
D St. (Missouri St. - Riverside Dr.)
Riverside Dr. (D St. - W. Main St.)
Volunteer Release of Liability Waiver
I hereby waive, release, and discharge any and all claims for damages, personal injury, or property damage which I may have, or which may hereafter accrue to me, because of participation in said volunteer work/activity. This release is intended to discharge in advance the City of Jackson, Tn., its officers, employees, or agents from liability, even though that liability may arise out of negligence or carelessness on the part of the persons or entities mentioned above. It is understood that some volunteer work/activities involve an element of risk or danger of accidents, and knowing those risks, I hereby assume those risks., It is further understood and agreed this waiver, release, and assumption of risk is to be binding on my heirs and assigns. Please enter the names of each person in your volunteer group (including the name of the person filling out the form) in the text area below. Please separate names with a comma (,). The addition of names to this list will not be accepted after approval.
*I have read and understood the foregoing form, liability release form, and agree to all of their terms and conditions.
Litter Pickup Agreement
Keep Jackson Beautiful, hereinafter called the “City” and aforementioned group, hereinafter called the “Group” recognizing the need and the desirability of litter-free roads are entering into this agreement to permit the "Group” to contribute toward the effort of maintaining litter-free roads within the City of Jackson, Tennessee. Click HERE to read the Litter Pickup Agreement
*I have read and fully understand the guidelines of the City of Jackson Trash 4 Cash Litter Program and agree to adhere to the conditions and terms of this Litter Pickup Agreement.
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