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Adopt-a-Trail Program: Environmental Clean-ups Completion Form

Town of Whitby Community and Marketing Services Department
500 Victoria Street West, Whitby, ON L1N 9G4
Phone: 905-430-4310 Fax: 905-668-5933
Email: parks.rec@whitby.ca Web: www.whitby.ca

This form is used by the Supervisor of Community and Marketing Services, Parks Development Division and the Supervisor of Operations or designates to keep track of the of Adopt-a-Park, Environmental Clean-up Program, participants, and the frequency of projects they are involved in. Please remember to always report information on this form after each clean-up.

Authorized Group Representative (AGR) Information:

First Name

Last Name

Phone Number

Email Address

Organization/Individual/Group Name

Date of Environmental Clean-up

Trail or section of trail:

Number of kilometers adopted

Number of bags of trash (approximately)

Next clean-up date

We participate in the recycling program

Yes

Number of kg of recycling to the transfer station

Were there any serious accidents or injuries during the clean-up?

Yes

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Adopt-a-Trail Program: Environmental Clean-ups Completion Form

Authorized Group Representative (AGR) Information: