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COVID-19 Community Cleanup Registration

2. Community Clean Up Registration Form

4. Group Leader First Name*

5. Group Leader Last Name*

6. Your Best Contact Number

8. Your Email Address*

10. Cleanup Date and Start Time*
    Cleanup Date and Start Time

    Cleanup Date and Start Time

11. Cleanup Location*

    List your cleanup location or let us know if you would like us to identify a place for you.

13. When will you be able to pick up tools?*
    When will you be able to pick up tools? Start Date

    When will you be able to pick up tools? Start Time

    —

    When will you be able to pick up tools? End Date

    When will you be able to pick up tools? End Time

    Please list two dates and times you are available to pick up supplies no more than 2 weeks prior to the cleanup date.

14. Tool Return*
    Tool Return Start Date

    Tool Return Start Time

    —

    Tool Return End Date

    Tool Return End Time

    Please give two dates you are available to return supplies, no more than 2 weeks after your cleanup date.

16. Comments

    Questions or concerns about tools, pick up, drop off, or anything else regarding your cleanup.

18. Are you 18 years old or older?*

    Choose one.
    Group Leaders must be at least 18 to register and lead a volunteer cleanup.

    1. Yes
    2. No
19. Signature*

    I agree to lead a volunteer cleanup in accordance with guidelines and safety procedures set by Keep Norfolk Beautiful and the City of Norfolk. If I need to change anything on this form I will email knb@norfolk.gov.

Leave This Blank:


21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit Submit and Print

* indicates a required field