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2. Organization Name
3. Organization Contact*
5. Email*
7. Address
8. City
10. Type of Project Requested*

    1. Adopt A Park
    2. One-Time Project
    3. Adopt A Street
11. No. of Estimated Participants
12. Age Range of Participants
14. Proposed Date*
15. Proposed Time*
16. Preferred Park/Location
18. On-site Contact Name and Number
20. Will you borrow a Supply Kit?

    1. Yes
    2. No
    3. Undecided
21. Supply Kit Pick Up and Return Time
23. Additional Information

    In addition to completing this interest form, there is some additional documentation we will need from you which will be emailed separately:

    1. Release and Hold Harmless (this includes a photo release). There is a separate form for minors.

    2. Follow-up numbers; how much trash you picked  up, etc.

Leave This Blank:


25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field