Charles County Government

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Adopt-A-Road Report A Cleanup

Adopt-A-Road Home | Adopt-A-Road Brochure | Forms and Agreements
Online Application | Report a Cleaning | Litter Facts/Games

Adopt-A-Road Litter Pick-Up Report Form

As part of our Adopt-A-Road agreement, participants are required to clean litter from adopted roadway(s) no less than three (3) times in a calendar year. Failure to comply may result in a voided contract. (Cleanup Form In PDF format)

Group/Individual (as listed on AAR sign):	*
Contact Person :
E-mail Address:
Phone:	*
Roadway(s) Cleaned:	*
Litter Pick-Up Date:
# Of Trash Bags:
Bulky Items (tires, etc.):
Please make one selection :	Collected trash needs to be removed from: (please specify trash location, i.e., "the intersection of ....." "area near AAR sign" "entire roadway" etc.) Collected trash has already been disposed of.
	* Required Fields