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:

Adoption Location:
Number of Participants:
Number of Hours:
Number of Bags Collected:
Estimated Weight of Bags:
in pounds

Pick up required?

Location of bags requiring pick-up:
Unusual or large items encountered:

Were there any injuries?
Are your signs OK?

Other Observations:
(This may include damage or obstructions on streets or trails,
condition of equipment, suggestions for improvement, or anything you wish to report.)