Litter Removal Form
Adopt-a-Street Group Name
*
Contact Person
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Date of clean-up
*
-
Month
-
Day
Year
Date
Number of miles adopted:
*
Number of volunteers:
*
Number of volunteer hours (number of volunteers x hours):
*
Number of trash bags:
*
Do you need assistance with removing the litter/debris your group collected? .
*
Yes
No
Please specify the location
*
Would you like to report any large debris or illegal dumping?
*
Yes
No
List the items and locations here
*
General comments
Please attach any photos of your group and/or any other photos of your findings
Attach an image
Browse Files
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of
Please verify that you are human
*
Submit
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