Clean Sweep Event

Group Information

Group Name:
Type of Group:

Coordinator Information

First Name:		Last Name:
Address:
City:		State:		Zip:
Phone Number:		Cell Phone Number:
Email:		Confirmation Email:

Alternate Contact Information

First Name:		Last Name:
Address:
City:		State:		Zip:
Daytime Phone:		Evening Phone:
Email:

Cleanup Information

Cleanup Title:
Cleanup Description:
Cleanup Date / Time:	/ / :
End Time:	:
Cleanup Location: (Please provide a detailed description of the area to be cleaned. Include street or creek name and starting/stopping point.)
Cleanup Location Zip Code:
Meeting Point: (please provide an address or street intersection)
Type of Cleanup:
Waterway: (if applicable)
Number of Volunteers Group is Providing:
Would you like additional volunteers referred to your cleanup? Number Needed:
Note to Volunteers:

Trash Collection Information

Do you need KAB to arrange to have the full trash bags collected? (no bulky items will be allowed)	Yes No
Closest address to where you’ll leave the full trash bags:		(exact address & zip code needed for mapping)
Description of where you’ll leave the full trash bags:		(If you are holding a park cleanup please note that you will leave full bags by the trash cans in the park. If your cleanup is not in a park please leave the full trash bags in one pile along a street and note the closest street intersection.)

Supplies

Gloves:		Bags:		Educational Door Hangers: (available for waterway cleanups)
Shirts (# of shirts requested must match # of volunteers group is providing)
Youth Small:		Youth Medium:
Adult Small:		Adult Medium:
Adult Large:		Adult X-Large:		Adult XX-Large:

Report

Total Number of Volunteers:		Total Number of Volunteers Under 18:
Total Number of Cleanup Hours:		Total Number of Volunteer Hours (Y*AA):
Number of Trash Bags Collected:		Number of Recycling Bags Collected:
Lbs. of Trash/Debris Collected:
Number of Miles Cleaned:
Most Unusual Object Found:
Volunteer(s) Attended Party
Comments:

Keep Austin Beautiful, 55 North I 35, Suite 215, Austin, TX 78702
Telephone Number: 512.391.0617 / Fax Number: 512.391.0624