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Adopt-A-Spot
Please print this form, complete it, and send it to Clean Fairfax Council after each cleanup.
Clean Fairfax
Council
Rosemary C. Byrne
Executive Director
12000 Government Center Parkway
Suite 467
Fairfax, Virginia 22035-0059
(703) 324-5471
Fax (703) 324-3950
Adopting Person/Group___________________________
Adopted Spot___________________________________
Address or Location______________________________
Cleanup Date_________________
Number of People Involved in Cleanup________
Total Number of Hours________
Total Number of Bags of Litter Collected________
Total Number of Bags of Recyclables Collected________
Comments______________________________________
_______________________________________________
_______________________________________________
Signature______________________________
Date__________________________________