AAM Supply Request Form

Organization Details
Organization / Group Name*
Contact Person*

First NameLast Name
Contact Persons Email Address*
example@example.com
Contact Persons Mobile Phone Number *
Details
Date of your Clean Up*

MonthDayYear
Date
Location / Street that you will be picking up (Street name, from where to where)*
Supplies

Proper Adopt-a-Mile supplies are a must when picking up along the sides of busy streets.The City of Brentwood will supply you and your group with the necessary safety equipment to pick up debris. You will be asked how many vests and pickers you need for your event. You are responsible for returning all equipment that is checked out.
Date that you would like to pick up your supplies*

MonthDayYear
Date
Adult Vests (MANDATORY ITEM)*
Child Vests (MANDATORY if youth on site)*
Trash Pickers*
Sets of Disposable Gloves*
Lastly
Along with the selection you made for your vests, pickers and gloves, you will be issued the following supplies:
- Roll of trash bags or multiple small rolls to make the equivalent of a large roll
- Small First-Aid kit for non-emergency injuries
- Hand Sanitizer pods
- Duffle bag for the vest, gloves and trash bags to be carried in
- Carry bag with stand for the trash pickers to be carried in
All these items (minus the used bags and gloves) are to be returned within 3 days of the completion of your event.
Would you like the City to remove the bags of debris you collect?*
Please list the approximate location that you will leave the bags for collection.*
Should be Empty:

Organization Details

Details

Supplies

Lastly