2. Group Name*
4. Contact Name *

   In case there is a need to follow-up with you

6. Contact Phone Number*
7. Contact Email Address*
9. Date your group's clean-up took place*
   Date your group's clean-up took place
10. Do you need KACCB to arrange to have the bags of trash and recyclable materials collected hauled away?*

    1. Yes
    2. No
11. Were any bulky items collected (items too large to fit in a bag)?*

    1. Yes
    2. No
13. Number of TRASH bags collected*
14. Number of bags of RECYCLABLE MATERIALS collected*
15. Description/type and quantity of BULKY ITEMS (if collected) - example: tires, furniture, scrap metal, etc.
17. Number of volunteers under the age of 18*
18. Total number of volunteers*
19. Amount of time volunteered (in hours (or fraction) / per person)*
21. If the bags (and/or bulky items) need to be hauled away, please provide a GPS searchable location where they were left behind (address, name of road, closest intersection)
22. Map screen shot or photo of location if address is not available
24. Photo of your group
25. Photo of trash and recyclable materials
26. Photo of stranger thing(s)
28. Comments/Questions
Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field