Come Clean! Application Form

Contact Information
Adopt-a-Block Information
The Adopt-a-Block Program requires cleanup events at least four (4) times per year. What are the approximate dates you plan to hold your cleanup events?
Adopt-a-Container Information
Participants of the Adopt-a-Container program must agree to the following requirements: • Adopt the container for a minimum of two (2) years • Keep surrounding area clear of litter and trash • Maintain plastic liners in the container at all times • Dispose of the bags of trash using your own receptacle
Clean-Up Information
Please describe the location where you will conduct a one-time cleanup: