Keep America Beautiful/Hartford Cleans Up Group Registration Form

Group Name/Affiliation
Contact Person
First Last
Phone
Address
Street Address City State / Province / Region ZIP / Postal Code
Email
Locations to be cleaned and/or beautified (public streets, parks, playgrounds and other public spaces within the community):
Date of Event
MM slash DD slash YYYY

Please pick up tools/supplies at KNOX the day before the event and return the day after the event.
Brief Description of Activity:
Number of Volunteers
Partner Organizations
Boxes of Trash Bags

Provide # of boxes needed (38 bags per box) PLEASE RECORD # OF GARBAGE BAGS USED.
Gloves

Provide # of pairs of gloves needed.
Brooms

Provide # of brooms needed.
Rakes

Provide # of rakes needed.
Shovels

Provide # of shovels needed.
Litter Picks

Provide # of litter picks needed.
Comments
I agree to return all tools (even those damaged or broken) and gloves to KNOX.*
- Yes, I agree.