Adoption Program Cleanup Report
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Adoption Group/Organization:
Your answer
Group Representative
Your answer
Address:
Your answer
City:
Your answer
State:
Your answer
Zip:
Your answer
Email:
Your answer
Cell Phone:
Your answer
Other Phone:
Your answer
Your Cleanup
Please provide this information as soon as your cleanup is complete to ensure trash is collected within a reasonable time.
Date of Cleanup
MM
/
DD
/
YYYY
Adoption Location:
Your answer
Number of Volunteers:
Your answer
Were safety procedures reviewed before the cleanup?
Your answer
Number of Adult volunteers:
Your answer
Number of youth (under 18):
Your answer
Project Duration (Hours)
Your answer
Miles or Acres
Your answer
Number of Trash Bags
Your answer
Number of Recycle Bags
Your answer
Materials that did not fit into bags:
Your answer
Detailed location of all bags and materials:
Your answer
Zip code for location of bags:
Your answer
Location of Adoption Sign(s)
Your answer
Color and number of Adoption sign(s) for indicated location:
Beautification/Restoration
Check all that apply
List types of Plants/Trees planted
Your answer
Invasive removal: Actual Weight of Invasives Removed (tons):
Your answer
Release and Waiver of Liability. I understand and agree that by executing this agreement I am expressly assuming the risk of and releasing Keep Tampa Bay Beautiful, Inc., a private non-profit organization, Hillsborough County, the City of Tampa, the City of Temple Terrace and any sponsors of the Project, and their respective directors, officers, employees, agents, contractors or representatives (collectively, the “Released Parties”) from all liability or responsibility whatsoever for any injury, death, or any other type of damages to me, my family, my heirs, my personal/legal representatives, or my assigns, however caused, that may occur as a result of my participation, including my travel to and from, the Project, including, but not limited to, injury, death or any other type of damages as a result of the negligence of any party, including the Released Parties, whether passive or active and regardless of the form of negligence. I assume full responsibility for the risk of bodily injury, death or property damage while participating, including traveling to and from, the Project, whether caused by the negligence of the Released Parties or otherwise and agree not to sue for any such cause.
Required
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