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2. Name of Adoption Group*
4. The Group Cleaned Up: *
   -- Select One --ParkStreamStreet

   Select whether the adoption group cleaned up a park, stream or street
6. Contact Name
8. Phone Number
9. Email Address
11. Home Address
13. City
14. State
15. Zip Code
17. Date & Time of Cleanup*
    Date & Time of Cleanup

    Date & Time of Cleanup
19. Area Cleaned*
    This will be the name of the park, stream, or street and where the group began and ended during the cleanup.
21. Location of Trash & Recyclables for Pickup
25. Report of Activities
27. Number of Volunteers *
28. Number of Volunteer Hours Worked
30. Number of Trash Bags
31. Number of Bags of Recyclables
33. Today's Date*
    Today's Date
Leave This Blank:


35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

* indicates a required field