Adopt-A-Road Cleanup Notification and Supplies Request

For questions filling out this form please contact adoptaroad@keepknoxvillebeautiful.org or call 865-521-6957.

Group Name *

Adopted Road Name *

Spokesperson Name *

Spokesperson Name

First Name

Last Name

Spokesperson Email Address *

Spokesperson Phone Number *

Spokesperson Phone Number

(###)

###

####

Tentative Date of Clenaup *

Tentative Date of Clenaup

YYYY

Number of Participants Expected

Support Needed *

Trash Bags

Gloves

Safety Vest

Litter Grabbers/Pickers

Traffic Safety Roadsigns

How will you dispose of the trash? *

Please have the Knox County Litter Crew come get the bags from the stretch of road we clean.

We will bring the bags to a Knox County Convenience Center

How and when would you like to receive your supplies? *

You can pick them up at the KKB office (preferred) or you can schedule a KKB staff member to deliver them (please specify an address)

Additional Comments

Please specify any specific quantities for supplies if it differs from the number of participants