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Keep Hollywood Beautiful Adopt-A-Street Event Completion Form

  1. Adopt A Street LOGO
  2. Please complete this form after finishing each cleanup event.

  3. To: City of Hollywood 

    Public Works Dept. 

    Attn: Charles Lassiter 

    1600 S. Park Road

    Hollywood, FL 33021 

  4. Phone: 954-967-4526

    Fax: 954-967-4510

    E-mail: smorin@hollywoodfl.org

  5. Group Leader

  6. Are your signs OK?*
  7. We encourage recycling; however, the nature of roadside litter may not be conducive to recycling. Any materials collected for recycling, as well as any income derived from them, shall be the property of the volunteers.

  8. Leave This Blank:

  9. This field is not part of the form submission.