Adopt-A-Street Online Cleanup Completion Report

2. 
4. What was the date of your Adopt-A-Street cleanup event?*
   What was the date of your Adopt-A-Street cleanup event?
5. Name of your group*

   Please let us know who we need to thank for your community service!

7. Group Leader or Contact First Name*
8. Last Name*
10. Email*
11. Phone*
13. What street(s) did you clean?*

    Please include the beginning and ending corners.

15. Start and stop times of your cleanup
    Start and stop times of your cleanup Start Time

    —

    Start and stop times of your cleanup End Time
17. How many people participated? Be sure to turn in the Volunteer Time Form when you return the cleanup items to City Hall.*
19. How many total bags did the group collect?*
21. Please tell us the location(s) of the bags so our Public Works crew can pick them up. It would be helpful to know the closest intersection to their location.*
23. Are there any large or heavy items that need to be picked up?*

    1. Yes
    2. No
25. Please let us know about any of the following so we may contact you

    1. We would like to hear from the Program Coordinator.
    2. Our Adopt-a-Street sign is damaged.
    3. We ran out of supplies or some of our equipment was non-functioning.
    4. We would like to reschedule our next cleanup event.
    5. None of the above, all went well.
27. If you took some pictures that we can post on the City website or on social media, please upload here.
Leave This Blank:


29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit

* indicates a required field