Wrap-Up Report Form
Please submit your wrap-up report within a week following your event. It is very important that Keep Polk County Beautiful, Inc. receives this form for reporting purposes.
Choose Event Type
*
Please Select
Adopt-A-Road
Community Cleanup
Waterway Cleanup
Beautification Event
Litter Free Event (Public)
If more than one, please list in the Description Area Below
Please enter your Group/Community/Individual Information Below
*
Event Information:
Please fill in all that apply
Cleanup Area, Roadway Name or Community
Number of Volunteers
Number of Hours project took to complete
Number of Bags of Litter collected
Number of Bags of Recyclables collected
Number of Flowers or Shrubs Plated
Number of Trees Plated
Number of Tires Collected
Number of Appliances Collected
Number of Furniture Items Collected
Number of "Snipe" Signs Collected
Approximately how many Miles of Cleanup performed
Check any additional that apply:
Railroad Cleanup
School Campus Cleanup/Beautification
Park Cleanup
Description of Event
For Adopt-A-Road Groups Only:
Do you need to schedule for your trash to be collected?
Yes
No
Location of bagged trash to be collected
Picture Upload - We love to see pictures of you out there - Keeping Polk County Beautiful!
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Number of Cardboard Trash Cans Supplied
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Should be Empty: