Form Center

Adopt-A-Stream Cleanup Scheduling Form

2. Stream Cleanup Details
   Stream cleanup dates and supply requests must be submitted via this form no later than two weeks prior to the event date. This ensures that we can safely coordinate supply drop-off and trash pickup. If you need confirmation on your trash pick-up location, please email sphilbin@rockvillemd.gov.

   Stream cleanup dates and supply requests must be submitted via this form no later than two weeks prior to the event date. This ensures that we can safely coordinate supply drop-off and trash pickup. If you need confirmation on your trash pick-up location, please email sphilbin@rockvillemd.gov.

4. Stream Section*
   -- Select One --CJ-01 Elwood Smith ParkCJ-02 Upper Dogwood ParkCJ-03 Lower Dogwood ParkCJ-04 Dawson Farm ParkCJ-05 Upper Ritchie ParkwayCJ-06 Lower Ritchie ParkwayCJ-07 Upper Potomac Woods ParkCJ-08 Lower Potomac Woods ParkCJ-09 Montrose Woods ParkCJ-10 North Farm ParkCJ-11 Cabin John Forest PreserveMP Monument ParkRC-01 Lincoln ParkRC-02 Northeast ParkRC-03 Maryvale ParkRC-04 West Civic Center ParkRC-05 North Civic Center ParkRC-06 Middle Civic Center ParkRC-07 East Civic Center ParkRC-08 Calvin ParkRC-09 West Rockcrest ParkRC-10 West Rockcrest ParkRC-11 Twinbrook ParkWB-01 King Farm WestWB-02 King Farm EastWB-03 Upper Watts Branch - South of Gude DriveWB-04 Upper Watts Branch - Carnation DriveWB-05 Upper Watts Branch - Mainstem to Nelson StreetWB-06 Upper Watts Branch - College GardensWB-07 Anderson ParkWB-08 Upper Woodley GardensWB-09 Lower Woodley GardensWB-10 Welsh ParkWB-11 Thomas FarmWB-12 FallsgroveWB-13 Upper Watts Branch ParkwayWB-14 Upper Woottons MillWB-15 Glenora ParkWB-16 Boulder CreekWB-17 Lower Woottons MillWB-18 Winding RoseWB-19 Rockmead NorthWB-20 Rockmead SouthWB-21 Wootton High SchoolWB-22 Watts Branch Park MainstemWB-23 Horizon HillWB-24 Redland Blvd West TributaryWB-25 Redland Blvd East Tributary

   CJ = Cabin John, RC = Rock Creek, WB = Watts Branch

6. Cleanup Date*
   Cleanup Date

7. Cleanup Time
   Cleanup Time Start Time

   —

   Cleanup Time End Time

8. Maximum Volunteer Limit*

   Recommended limit is 15 volunteers. This can be increased if the stream allows for more volunteers to social distance at least 6 feet. Events must not exceed 25 people per the Montgomery County social gathering limit.

10. Team Leader Name*

11. Group Name*

13. Phone

14. Email*

18. Clean Up Supply Request
    Supplies will be dropped off with no-contact to the address indicated below no later than 3 days prior to your cleanup date. Walk-in supply requests to City Hall cannot be accommodated. Volunteer Liability Waivers and Student Service Learning Hour forms will be provided in PDF form via email.

    Supplies will be dropped off with no-contact to the address indicated below no later than 3 days prior to your cleanup date. Walk-in supply requests to City Hall cannot be accommodated. Volunteer Liability Waivers and Student Service Learning Hour forms will be provided in PDF form via email.

20. Do you require supplies for your cleanup?*

    1. Trash Bags
    2. Gloves
    3. Paper SSL Forms
    4. None

22. Number of trash bags requested:

24. Number and sizes of pairs of gloves requested:

    Available sizes are Youth (ages 8 and up), Small, Medium, Large and Extra-Large.

26. Number of paper SSL forms requested:

28. Supply Drop-Off Address

30. City

31. State

32. Zip

34. Special instructions for supply drop off:

    Ex. leave at front door, on porch, front desk etc.

36. Additional Questions/Comments:

Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

* indicates a required field