Adopt-A-Roadside Program

Litter Pickup Form

The Adopter Representative shall organize a litter pickup work effort a minimum of four (4) times per year, at least once every three (3) month quarter, during daylight hours. Failure to comply with this quarterly requirement shall result in termination of the Memorandum Of Understanding for the Adopt-A-Roadside Program (as signed by Adopter Representative) and result in removal of the Adopt-A-Roadside recognition signs.

* Fields are required

    Adopter Representative:
    Adopted County Roadside: *

                             (Name of street)

     Limits of Adopted
    County Roadside:

                             (Name of intersecting streets)

    Date of Litter Pickup: *
* Required