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2. 
4. Cleanup / Project / Task Report Form
6. Today's Date (Date of Form Submission)
   Today's Date (Date of Form Submission)
7. Program Participating In (Please check box)

   1. Adopt-A-Park
   2. Adopt-A-Spot-in-a-Park
   3. Community Cleanup
   4. Great American Cleanup
   5. Project Cleanup
   6. Other (no specific program)
9. Group Leader Name*
10. Organization Name
12. Address
14. City
15. State
16. Zip Code
18. Phone Number*
19. Email Address*
23. Cleanup / Project / Task Information
25. Date of Cleanup / Project / Task*
    Date of Cleanup / Project / Task
26. Location of Cleanup / Project / Task
28. Tasks Completed / Comments
30. Volunteer Information
32. Number of Volunteers*
33. Number of Hours*
35. Total Volunteer Hours*
37. Trash Information
39. Number of Bags Collected
40. Total Pounds of Trash
42. Recycling Information
44. Number of Bags Collected
45. Total Pounds of Recycling
49. Safety & Orientation Confirmation

    By typing my/our name(s) below, I/we confirm that a Safety & Orientation meeting was held with volunteers prior to the start of the above project. 

51. Date and Time of Safety & Orientation Meeting*
    Date and Time of Safety & Orientation Meeting

    Date and Time of Safety & Orientation Meeting
53. Group Leader Name*
54. Safety Coordinator Name*
58. Photos: Please take photos of your cleanup or project with a "Keep Chesapeake Beautiful" flag and upload them below. Photo file size should be 10 MB maximum.
60. Photo #1
61. Photo #2
63. You may also email photos to SpecialPrograms@CityofChesapeake.net but please make sure you include details like your organization name, date and location of project, etc.
Leave This Blank:


65. 1. Receive an email copy of this form.
66. Email address

    This field is not part of the form submission.

67. Submit Submit and Print

* indicates a required field