Cleanup Report

First Name *

Last Name *

Email *

Date of cleanup *

Where did your cleanup take place? *

Roadside
Neighborhood
Park or open area
Commercial property
In or near waterway
Other

Briefly describe the location of cleanup if "Other" is checked:

Zip Code of your cleanup *

County/City where your cleanup took place *

Number of bags of litter collected *

Number of bags of recyclable items collected: *

# of Volunteers *

# of Hours *

Who was involved with the cleanup? *

Individual(s)
Scouts
School Group
Faith Group
Business or Employer
Other

Please state a description of who was involved in the cleanup if "Other" is checked:

Any beautification projects other than a litter cleanup, such as trail clearing, graffiti removal, etc.?

Are you the recipient of a KVB Cleanup Kit? (We like to track the activity of our kits)? *

Yes
No

Are you real?