2. To identify and assign a project for your group, KACCB will need some basic information. NOTE: Assignments for Down and Dirty roadside litter clean-ups are based on real-time litter conditions. Therefore, the location of the roadside clean-up and all additional relevant information will be shared the week before a clean-up is scheduled to take place.
4. Group Information
6. Group name:*
8. Contact name:*
10. Contact phone number:*
12. Contact email address:*
14. Number of volunteers expected to participate:*
16. ATTENTION!

    Please be advised that in observance of the MLK Day holiday, KACCB will be closed on Monday, January 19th. 

    As a result, groups will need to arrange to pick up their tools on either Friday, January 16th. Or, on Wednesday, January 21st, Thursday, the 22nd, or Friday the 23rd.

    KACCB apologizes in advance for any inconveniences this may cause your group and thanks you in advance for your flexibility and understanding.

18. Date volunteers are available (month/day/year):*
20. Type of assignment desired (please identify what type of assignment or special interest your group prefers. Examples include: community/school garden maintenance, invasive plant removal, roadside litter clean-up, etc.).*

    NOTE: Parks and trails are managed and maintained by the ACCGov Leisure Services Department and are outside of KACCB's jurisdiction. Therefore, KACCB will forward all requests for assignments at parks or trails to staff at ACCGov Leisure Services. They will determine if they have a need and/or a project available on the date(s) identified.

22. Participant age(s) - check all that apply:*

    1. Children (elementary aged)
    2. Youth (middle school aged)
    3. Young adults (high school aged)
    4. Adult (college and above)
    5. Seniors (needing arrangements to account for limited mobility)
    6. Special needs (please specify)
24. Please indicate, if applicable:

    1. limited mobility
    2. other (see box to the right)
25. Other (please specify):
27. Please Be Advised - For groups interested in LITTER CLEAN-UPS:

    If your group is interested in conducting a litter clean-up, the location your group will be assigned to clean-up will be determined and based on real-time litter conditions. Groups will receive a map and all additional relevant information needed to conduct a safe and successful clean-up the week leading up to their scheduled clean-up. 

    KACCB will keep correspondence at a minimum until an assignment for your group has been identified. However, if you wish to review or further discuss potential details pertaining to your groups' scheduled litter clean-up, please call 706-613-3501, extension 7871.

Leave This Blank:


29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit

* indicates a required field