Monthly Clean-up Form Monthly Clean-up Report Please complete this form after finishing each clean-up event. If you have adopted more than one street, trail or park, please complete one form per location. Clean-up Date: Contact Name* Phone: Address: Email* Organization Name: Adoption Program: Adopt-a-Block Adopt-a-Trail Adopt-a-Park Adopt-a-Creek Adoption Location: Number of Participants: Number of Hours: Number of Bags Collected: Estimated Weight of Bags: in pounds Pick up required? Yes No Location of bags requiring pick-up: Unusual or large items encountered: Were there any injuries? Yes No Are your signs OK? Yes No Other Observations: (This may include damage or obstructions on streets or trails, condition of equipment, suggestions for improvement, or anything you wish to report.) 3+4=?