Cleanup Results Form

You must submit a new form and photos for each day of service
Submit Before, After, and Group Photos (5 photos)
Submit photos by email to kmb@keepmidlandbeautiful.org

Name of Group
Name Name First Last
Phone Phone - ### - ### ####
Email
Date of Cleanup Date of Cleanup / MM / DD YYYY
Location of Cleanup
Number of Adult Volunteers (18+)
Number of Children Volunteers (17 & below)
Number of Hours Group Cleaned
Number of Bags Collected
Program Type
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5, 6, 7, 8 : the 4th number is?