Welcome to the Adopt-A-Program Supply Request form! Please fill out the following form to request cleanup supplies from Keep Allen Beautiful. These supplies are available for adopters and community members interested in doing one time cleanups.

Organization Name:*

Your Name*

E-mail*

Phone Number*

Date of Cleanup*

Supplies may be picked up at the Utility Billing window at City Hall. You will receive a confirmation e-mail in two business days.

Supply Pickup Date: (Please allow 1-2 weeks notice for all supply requests)*

Approximate Number of Volunteers*

Cleanup Type*

Adopt-A-Highway Adopt-A-Spot Adopt-A-Waterway One Time Cleanup (Non-Adopter)

Cleanup Location (List assigned area number whenever possible or intersection)*

Pickers? (Pickers are limited to 1 per 5 volunteers)*

Yes

No

Safety Vests (Request safety vests if you're group is near major highways, highly dense forest, or has children).*

Yes

No

Yellow Litter Bags (Use smaller bags for individual collections then combine them into larger yellow bags. Leave them by the roadway or adoption sign for collection.)*

Yes

No

Latex Gloves (1 glove per volunteer. It is supposed to be worn on the hand collecting litter. This limits the amount of waste we create during the cleanups).*

Yes

No

Leather Gloves (These are for heavy duty cleanups that require bulky items. 1 or 2 pairs are usually offered per group).*

Yes

No

Thank you for filling out the form. It will be sent to the Adopt-A-Program coordinator, Josué Diaz. He can be reached at 214-509-4555 or jdiaz@cityofallen.org. Please allow 3-5 business days for a confirmation.