Keep High Point Beautiful Adopt-A-Street Reporting Form

2. 

4. Name of Adopting Group*

6. Team Captain

7. E-mail Address or Phone Number*

9. Address of Cleanup Site*

11. Date of Cleanup
    Date of Cleanup

12. Start Time of Cleanup
    Start Time of Cleanup

13. End Time of Cleanup
    End Time of Cleanup

15. Check this box if you disposed of the litter yourself. (Ex. you threw it in your personal garbage can.)

    1. Disposed of it personally

17. If you did not dispose of it yourself please let us know the location of the bags so that we can pick them up.*

    Type "n/a" if you disposed of the litter in your personal trash.

19. # of Volunteers

20. # of Bags of Trash (Orange Bags)

22. # of Bags of Recyclables (blue bags)

23. Number of Misc. Items and Description (ex. TVs, Tires, 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