Adopt-A-Stream / Adopt-A-Block Notification Form

Please complete and submit prior to cleanup.

Name of Group/Organization:
Contact Person:*
Date of Cleanup:
Time (start and end):
Meeting Location:
Other Groups:
Supply Request:
Other Requests:
Cleanup Trash P/U Location:
Number of Volunteers:

Total Number of Participants:

Youths   Adults
Must be 12yrs. or older.
All participants under 18 yrs
must have signed parental consent.
Who will supervise the project?
Drop off and pick up
point of contact and
street address:
Properly secure and completely tie all bags. Separate burnable and recyclables (e.g. tires, batteries, metals, plastic bottles, aluminum cans, etc.) Group the bags together and indicate the location for waste collection and disposal. Please do not block sidewalks.
Please allow a minimum of two weeks processing time.
* Required fields