Material Request Form

Adopt-A-Spot Material Request Form

* Indicates required field

Name of Group/Organization *

Contact Person *

First

Last

Adopt-A-Spot Location *

Email (Contact Person) *

Phone Number (Contact Person) *

Alternate Number *

Date of Cleanup *

List the date when you would like to pick up the supplies. *

Approximate number of people volunteering *

Please check what supplies you require (the amount of supplies will be based on the number of people volunteering) *

Bags Gloves Grabbers Safety Vests

I understand I should follow COVID-19 guidelines – Wear gloves and maintain a 6’ distance. Bring a mask for passing within 6’ of others. If you encounter littered gloves, masks or PPE, please use care and review this guide for safety tips. Dispose of your single-use face masks and disposable gloves in a trash can (not a recycle can). *

Check box to concur.

You are responsible to dispose of all the trash bags in a responsible manner.

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