Adopt-A Program Report Form
Date of Trash Pickup
*
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Month
-
Day
Year
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Organization's Name
*
Location
*
Site Leader's Name
*
First Name
Last Name
Contact's Email
*
Number of Adult Volunteers
*
Number of Youth Volunteers
*
How many hours did the clean up last?
*
Number of Bags Filled
*
Number of Tires Collected
*
My group disposed of my litter
*
YES
NO (if no, list cross street where bags are placed, below, in "Other")
Other
Number of Bags of Recycling Collected
My group picked up cigarette butts?
If Yes, How many?
Upload ALL VOLUNTEER SIGNATURES HERE
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We must have on file signatures of ALL volunteers for your group each year.
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Submit favorite cleanup photo here.
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