Adopt-A-Spot Litter Pickup Report

2. Group / Individual (as listed on Adopt-A-Spot sign)*
3. Contact Person (Name)*
5. Contact Phone Number*
6. Spot Cleaned (street, neighborhood, or general description of area)*
8. Event Date*
   Event Date
9. Event Time Span*
   Event Time Span Start Time

   —

   Event Time Span End Time
11. Total Number of Adult Participants*
12. Total Number of Youth (Under 18) Participants*
14. Total Number Participants*
15. Total Trash Collected*

    (Please indicate container size and number of containers filled.)

17. List Any Bulky Items (tires, shopping carts, etc.)
18. Select One

    1. Collected trash has already been disposed of.
    2. Collected trash needs to be removed.
20. Location of Trash Pick-Up

    Specify trash location, i.e., "the intersection of..." "area near AAS sign" "east end of Oak Avenue" etc.

Leave This Blank:


22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

* indicates a required field