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Adopt-A-Street Program Clean Up Completion Form

2. After each street clean up event, please fill out this form completely.

   After each street clean up event, please fill out this form completely.

4. Please return unused supplies to the City's Community Development Building, 305 SW A Street, 2nd floor.

   Please return unused supplies to the City's Community Development Building, 305 SW A Street, 2nd floor.

6. Participant Information

8. Organization Name:

10. Address:

12. Contact Person Information

14. Contact Name:

16. Email:

17. Phone:

19. Adopt-A-Street Assignment

21. Street Name:

22. Section:

24. Clean Up Event Details

26. Clean Up Date:
    Clean Up Date:

27. Number of Volunteers:

28. Volunteer Hours Worked:

29. Total Bags Collected:

31. Clean Up Event this Year:

    1. 1st
    2. 2nd
    3. 3rd

32. Location where filled trash bags were left for city crew to pick up:

Leave This Blank:


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

    This field is not part of the form submission.

36. Submit

* indicates a required field