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2. Name of Adopting Group:*
4. Contact Name*
5. Email Address*
7. Phone Number*
11. Date of Cleanup:*
    (Month/Day/Year)
12. Time:
14. Area Cleaned:*
16. Location of bagged trash and recyclables (for pick-up):*
18. Number of Volunteers:*
19. Number of Hours Worked:*
20. Number of Trash Bags*
22. ***Most litter collected by Adopt-A-Street participants should fit into trash bags provided. Bags of trash should not exceed 20 pounds. IF 3 OR LESS BAGS OF TRASH ARE COLLECTED, WE ASK THAT THE ADOPTING GROUP DISPOSE OF THEM. The Adopt-A-Street contact person should call the Village of Clemmons Public Works (336-766-9170) the following work day to tell where bags have been left.
24. PLEASE KEEP ANY UNUSED BAGS, GLOVES, OR VESTS FOR NEXT CLEANUP!
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26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field