Adopt-A-Spot Request Form

2. 
3. Adopt-A-Spot Request Form
   Please complete the following information for yourself/your organization. Your request will be processed and the Beautification Coordinator will contact you. If you have any questions or special needs, please call 757-890-3780.
5. Name of Group / Individual
6. Primary Contact
8. Mailing Address
9. E-mail Address*
11. City
12. State
13. Zip Code
15. Home Phone Number
16. Cell Phone Number
18. Please fill in the type of spot to be adopted as well as location
20. Park
    (Provide Name of Park)
21. Creek
    (Provide Name/Location of Creek)
22. Drain
    (Provide Location of Drain)
24. Median
    (Provide Location of Median)
25. Block (curb & sidewalk)
    (Provide Location)
26. Other
    (Please Describe)
28. What is the location or nearest address of your adopted spot?
29. Approximately how many volunteers will be working in the spot at one time?
31. Approximately, how often do you plan to clean the site? Minimum commitment is twice per year
    Example: Daily, 3x Per Week, Weekly, Monthly, Bi-monthly, etc.
Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

* indicates a required field