Submit Cleanup Report

Submit Cleanup Report
We appreciate your participation in our Adopt-a-Program and your commitment to the City of Greensboro! This form serves to ensure that we have a record of your cleanup efforts and to notify staff of any concerns with your adopted location.

Anyone who submits a form should be aware that in accordance with the North Carolina Public Records law, found in North Carolina General Statutes Chapter 132, their e-mail address is considered public record.
Cleanup Date*

MonthDayYear
Date
Name of Group/Organization*
Contact Person*

First NameLast Name
E-mail*
example@example.com
Phone Number*
Format: (000) 000-0000.
EmailPhone
Adopt-a-ParkAdopt-a-Stream/Clean-a-CreekAdopt-a-StreetAdopt-a-Trail

Name of cleanup site*
Number of adult participants
Number of youth participants (under age 18)*
Number of hours spent on cleanup*
YesNo
What is the location of bags for pickup?*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What is the location of bags for pickup (nearest cross street)?*
E.g., Northbound corner of North Ave. and East St.
Number of bags collected
Type of debris removed (i.e. tires, paper, plastic, etc) *
Rating Assessment Area
- Rate the area 1 through 5 stars: 1 meaning the area needs immediate attention and 5 meaning the area is excellent.
- Please note if anything looked unnatural or out of the ordinary during your visual inspection.
General items (ie. benches, tables, signage, graffiti)
Improvements/Comments
Playground equipment, basketball court
Improvements/Comments
Shelters/Rooms (ie. restrooms, sidewalks, roofing, etc.)
Improvements/Comments
Environmental (ie. creeks, creek banks, poisonous plants, bees/hornets, insects, wildlife, etc.)
Improvements/Comments
Trail markings, signage, etc.
Trail markings improvements/comments
YesNo