Updated Adopt-A-Spot Litter Program Application

Adopt-A-Spot Litter Program Application

To apply for the Adopt-A-Spot Litter Program, fill out the following information.
Name of Organization/Individual:
Contact Name:

First NameLast Name
Contact Email:
example@example.com
Contact Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Mailing Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Location of proposed Adopt-A-Spot Litter Site:
With whom have you discussed your interest in adopting the site for litter cleanup:
How will your volunteers be kept safe during their project times?:
The proposal will be reviewed by HCCC staff and forwarded to the appropriate City department(s) and other public bodies, as needed, for technical review and approval.

HCCC staff will communicate with the adopting individual or organization if additional information or modifications to the application are requested during the technical review process.

HCCC staff will notify the adopting individual or organization regarding the outcome of the technical review.

By submitting this application, the applicant confirms they have reviewed the Litter Program information at hampton.gov/1758/Litter, including the Litter Agreement and its Terms and Conditions, and the applicant understands that their application is not approved until a Litter Agreement has been fully executed by both the applicant and the City.

Please read the following and sign the application form below.

I hereby certify that all answers and statements made on this application are complete and accurate. I understand that any misleading, misrepresentation and/or omission of information on the application is grounds for discharge from the program.

Please sign and date below to signify your certification:
Signature
Should be Empty:

Adopt-A-Spot Litter Program Application

Please read the following and sign the application form below.