School Litter Audit – Registration Form

School Litter Audit – Registration Form
*To be completed by classroom teacher and/or student group leader.

School:
Class Grade or Student Group:
Teacher/ Leader Full Name:
Phone:
Email:
School Address:
Litter Audit Date:

1. How many students are in the class/group?

2. What are the ages of students?

3. Will ALL students in your class or group be able to participate in the
litter clean-up activity?  Yes No If No, please explain:

4. Has your class or student group been active or currently active in litter control efforts in and around your school yard or the community? Please share:

5. Has your class or student group participated in a Mission Adopt-A-Block education activity or other community clean-up event in the past? Please share:

6. Would you be interested in receiving information on other Mission Adopt-A-Block education activities? Upcoming events? Newsletters? If so, please include email address: