Supply Form

All groups must fill out the safety pledge in order to receive supplies and be included in the Clean Communities Program.

Group Name:
Group Leader Name:
Pick-up Date:  [None] Select a Date Delete the Date  

Items Borrowed
Gloves:  pairs
Safety T-shirts:
First Aid Kit box:
"Litter Patrol Ahead" Signs:
Grab Its:
Black Bags:
Clear Bags:
Hand Sanitizer (Limit 2)
Face Masks (Limit 5)
Other Items:  


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