1

Contact Information

 *

Contact Information

Name

Name of Organization

Address

Address 2

City, State, ZIP Code

Email Address

Daytime Phone

Evening Phone

2

Requested Adopt-A-Spot Location

 *

Requested Adopt-A-Spot Location

Requested Adopt-A-Spot Location

Approximate number of people participating in litter cleanup effort

3

Are any volunteers below 18 years of age?: (Minors must have parent or guardian permission and adult supervision.)

 *

Are any volunteers below 18 years of age?: (Minors must have parent or guardian permission and adult supervision.)

Yes

No

For questions or to manually submit your application:
Public Works Department
Attn: Tony Donati
220 Fourth Ave. S.
Kent, WA 98032
Direct: 253-856-5589 Fax: 253-856-6500
tdonati@kentwa.gov

Your application will be reviewed by staff. Once approved, you will need to complete an Agreement, Hold Harmless Form, and participate in Safety Training prior to your first cleanup activity. If your location is not approved, staff will work with you to find a suitable alternative location.

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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