Adopt-A-Road Cleanup Notification and Supplies Request

Please give at least one week notice for supplies and litter crew 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 Cleanup *

Tentative Date of Cleanup

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 or City of Knoxville Public Service come get the bags from the stretch of road we clean. (Group must verify when cleanup is completed)

We will bring the bags to a Knox County Convenience Center or dispose of myself

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