Form Center

2. 
4. Earth Day Community Clean Up- Richmond County, NC 2021
8. ABOUT
10. Richmond County Government is partnering with multiple communities within the county to provide convenient locations for concerned citizens the opportunity to pick up garbage and clean up their neighborhoods.
12. Register for our county-wide volunteer litter pick up event that will be held April 24, 2021 from 8am - 11am. Individuals, families, businesses and groups of all sizes* and types are welcome to join the fun!!!
14. *Due to COVID-19 we ask that groups be 20 or fewer per pickup site.
    We can assist you with multiple locations if your group is greater than 20.
16. You will be provided with a location assignment, bags, gloves, vests (if needed) and arrange to have your filled bags picked up! Pickup locations for supplies will be announced.
18. For more information on EARTH DAY please visit: https://www.earthday.org/earth-day-2021/
22. Date: Saturday, April 24, 2021 [ Rain Date: Sat. May 1st ]
24. Time: 8:00am - 11:00am
26. Locations: To Be Announced
30. GENERAL CONTACT INFORMATION
32. Group Name- Optional
33. Group Type:
    -- Select One --Company/ OrganizationFaith Based OrganizationFarmFriends/ FamilySchool/ CollegeOther
34. Other:
    Please explain.
36. Name:*
37. Contact Phone Number:*
38. Email Address:*
40. Mailing Address:*
41. City/ State/ Zip*
43. Deadline for Volunteer Registration- Friday, April 2nd
45. Number of Volunteers in your Group*
    This can be an estimate; we know that the numbers will fluctuate between now and the event. >>> We ask that groups be limited to 20 per cleanup location>>> we can assist you with multiple locations if your group is greater than 20.
47. Will there be children (12 and younger) participating with your group? *

    1. Yes
    2. No
49. Do you know where you want to help pick-up litter or are you unsure at this time?*

    Please check one

    1. Yes
    2. No
    3. Unsure at this time
51. I want to pick up litter in:*

    Select one

    1. the area of most need: please name in field below
    2. a park or along a trail: please name in field below
    3. a stream or creek clean up: please name in field below
    4. an "Adopt-a-Highway" road: please name in field below
    5. a Leader Led Site: routes to be announced, or have leader contact Jacqueline Welch (910) 997-4491
    6. my neighborhood: please name in field below
    7. Other: please name in field below
52. We can assist you with choosing a location by selecting from the options below.

    1. I would like to pick up in the are of most need
    2. A park or a trail.
    3. A stream or a creek.
    4. an "Adopt-a-Highway" road.
54. Please name area of most need here.*
56. Please name park or trail here.*
58. Please name your stream or creek clean up location.*
60. Please name your Adopt-a-Highway.*
62. Please name your neighborhood location.*
64. Please name your leader led site location?*
66. Other: please name location here*
68. Is there anything else you would like to share with us at this time?
72. How did you hear about this event?
74. How often would you be willing to hold an event like this in your community again?

    1. Monthly
    2. Quarterly
    3. Twice a year
    4. Once a year
    5. Other:
75. Other:*
79. ON THE DAY
    Please consider bringing yourself a reusable water bottle, hat, sunscreen and a chair.
81. Suggested Hashtags:
    #agingisgood #RichmondCountyNC #RestoreOurEarth #EarthDay #earthdayeveryday #plasticpollution #takeaction
83. As A Group Leader:
    Please provide your group volunteers access to water during this event. Provide chairs for any volunteers that may need to take breaks due to their health or age.
87. SPONSORSHIP
89. Deadline March 25th
    If you are interested in providing a sponsorship for this event, please contact Jacqueline Welch, Executive Director of Richmond County Aging Services at 910-997-4491 or email jacqueline.welch@richmondnc.com
93. If you are interested in submitting a specific priority clean up area please click here.
    Click Here
Leave This Blank:


95. 1. Receive an email copy of this form.
96. Email address

    This field is not part of the form submission.

97. Submit Submit and Print

* indicates a required field