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2. City of Allen Collection Statistics Form
4. Date*
   Enter the day of clean up.
6. Event*
   -- Select One --- Please Select - Adopt-a-Highway (Contracted Only)Adopt-a-Spot (Contracted Only)Adopt-a-Waterway (Contracted Only)One Time Clean-upProbationary Clean-up Event

   If contracted, select "Highway," "Spot," or "Waterway." If your group is on probation select "Probationary Clean-up Event." If you're not under contract then select "One Time Clean-up" for each clean up.
8. Organization
   List Name of Organization as Listed on Contract If Applicable
9. Clean-up Area
   List Adopter Area Number or Detailed Road Explanation
11. Number of volunteers participating:
13. Over 18 years of age*
14. Under 18 years of age*
16. Number of bags collected
    Enter the total bags collected.
17. Items too large for bags (estimated weight):
    Enter the estimated weight in LBS of oversized or odd items.
19. Number of hours spent collecting:*

    1. .5
    2. 1
    3. 1.5
    4. 2
    5. 2.5
    6. 3
    7. 3.5
    8. 4
    9. 4.5
    10. 5
    11. 5.5

    Please round to the nearest half-hour:
20. Location of bags needing pickup:*
21. Distance Cleaned
    List the approximate distance cleaned in miles. Your route x2.
23. REMINDER: Don't forget to report broken items. If not under contract, please return all supplies to the Utility Billing Window at City Hall within 3 days of your cleanup. Formal Adopters will need to restock during contract season (October - December).
25. Group Leader / Contact Name*
26. Phone Number*
28. Email Address
29. Please indicate if your contact information has changed.

    1. Yes
    2. No
Leave This Blank:


31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

* indicates a required field