COMMUNITY CLEAN-UP DAY : HELP KEEP BRIMFIELD CLEAN

Name

This address will receive a confirmation email

Cell Phone

Group / Team Name

Number of People in Group/Team

Would you like a street, wooded area, or community area assigned to you?

Yes No

Name of street, wooded area, or community area you are cleaning.

(Please enter N/A if you answered "YES" to have a area assigned to you)

Starting Point (House Number or Intersection)

(Please enter N/A if you answered "YES" to have a area assigned to you)

Ending Point (House Number or Intersection)

(Please enter N/A if you answered "YES" to have a area assigned to you)

Notifications will be sent via e-mail to those people/groups that have signed up for the same road, wooded area or common community areas.

Acceptance of Responsibility

I acknowledge that I am assuming all risks associated with this fun and exciting community activity.

Description

Please fill out this form and click submit.