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Agreement

By filling in and submitting this form, you agree that the following statements are true:

  • I have a mobility-related disability which prevents me from getting my recycling or garbage to the curb/lane for regular pickup.
  • There is no one living at the same address who can take my recycling or garbage to the curb/lane for me.
  • I have reviewed and agree to comply with the Guidelines and Regulations for the Assisted Waste Collection Service.
  • I understand that I may be required to provide supporting documentation from a health care provider substantiating information regarding my disability before final approval is provided.

Eligibility, duration of service, and other information can be found on the Assisted Waste Collection page. It is recommended that you read all the information on that page before applying.

Applicant Information
Enter your first name.
Enter your last name.
Enter your telephone number in 555-555-5555 format.
Enter the time of day (hh:mm am/pm) when you would like us to contact you.
Enter your address.
Enter your postal code.


Enter your email address so we can contact you about this application if necessary.
Enter any additional information

This information is being collected under the Authority of Section 33 (c) of the Freedom of Information and Protection of Privacy (FOIP) Act and will be used to contact you regarding your application for assisted waste collection. Your personal information is protected by the privacy provisions of FOIP. If you have any questions about the collection, use and disclosure of your personal information, contact the City of Edmonton at 311.

Before clicking "Submit", please ensure that you have read the agreement at the top.

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