2. Organization's Name
   If volunteering as a group, please list the Organization's name
4. First Name
5. Last Name
7. Address
9. City
10. State
11. Zip Code
13. Email Address
14. Phone Number
15. Approximate Number of Individuals
    If volunteering as a group, please indicate the number of volunteers attending
17. Please select either a Litter Clean Up Site or a Work Project Task
19. Litter Clean Up Sites
    -- Select One --Avilee Webb ParkAnna Dean ParkBCF Sports ComplexBreitenstine ParkCarl Harter ParkCollege ParkCrisman ParkDecker ParkEdgewood ParkLake Anna ParkMcCafferty ParkNew Portage ParkWaltz Park and Conrad ParkCoventry RoadVan Hyning NeighborhoodMagic City Shopping PlazaLockwood RoadGiant EagleOhio/Erie Canal TowpathNorton AvenueEastern RoadState Street BridgeHopocan AvenueBaseball fields behind Barberton Elementary EastDowntown BarbertonArea Churches

    Please select the location which you wish to clean up
20. Work Projects
    -- Select One --Waltz Park- Rake in Cemetary, clean up rubber chipsDowntown Barberton- Sweep sidewalks and clean up landscapingTuscarawas Ave & 2nd St.- Clean and sweep on 3rd & 4th StreetsAvilee Webb Park- Clean up landscaping and leaves, rake rubber chipsBCF Sports Complex- Rake rubber chips and put back in playgroundCollege Park- Rake rubber chips and put back in playgroundCrisman Park- Rake rubber chips and put back in playgroundDecker Park-Rake rubber chips and put back in playgroundEdgewood Park-Rake rubber chips and put back in playground

    Please select the work project you wish to perform
Leave This Blank:


22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

* indicates a required field