2. 
4. 

6. General Information (Required)

8. First Name*
9. Last Name*
11. Name of Site Coordinator:*
12. Organization:*
14. Email*
15. Phone Number*

17. Terms & Conditions

    We hereby agree to participate in "Growing Green with Pride" Cleanup Day in Prince George's County on Saturday, October 21, 2023, rain or shine. We understand that this beautification and street litter pickup activity provides an opportunity for community organizations, schools and businesses to partner with Prince George's County Government to celebrate community pride, volunteerism and commitment in our neighborhoods. We understand that the mulch provided by the County must ONLY be installed in public areas. We encourage volunteers to practice social distancing and wear face coverings and gloves while participating in this event. 

19. Who Owns the Site(s)?

21. (Please check one)*

    1. County
    2. M-NCPPC
    3. State
    4. Public Areas
    5. Schools
    6. Other (Please specify):
22. Please specify other:
24. Did you get permission from the property owner or school principal to enhance the site(s)?

    1. Yes
    2. No
26. From whom did you get permission?
28. Name:
30. Position:
32. Phone:
34. E-mail:

36. Number of Volunteers Involved in Cleanup

38. Adults:*
39. Students:*

41. Supplies

    Your group will be provided with gloves, trash bags, litter grabbers and safety vests. Please leave your filled trash bags along the curbside of the roadways you identify to be cleaned. The Department of Public Works and Transportation will pick up the trash bags.

    Mulch (6 max)

43. 

45. Name of Street(s) to Be Cleaned

47. Street Number (or closest block of):*
48. Street Name:*
50. Street Number (or closest block of):*
51. Street Name:*
53. Street Number (or closest block of):*
54. Street Name:*
56. Street Number (or closest block of):*
57. Street Name:*
59. Street Number (or Closest block of)
60. Street Name
62. Street Number (or Closest block of)
63. Street Name
65. Street Number (or Closest block of)
66. Street Name
68. Street Number (or Closest block of)
69. Street Name

71. Community Service Hours

    Prince George's County Public Schools students who would like to earn service learning hours by volunteering at the community clean up may request forms and establish group information from their school's guidance office and have them signed by the cleanup coordinator at their assigned group/community cleanup site.

75. Mandatory Tree Planting Workshop

    The Group Site Coordinator MUST attend one mandatory Tree Planting Workshop co-sponsored by the Department of Public Works and Transportation, Neighborhood Design Center and M-NCPCC. To schedule a workshop, indicate your preference below:

77. Mandatory Tree Planting Workshop*

    1. Thursday, October 12 @ 6PM: Bladensburg Waterfront Park | 4601 Annapolis Road, Bladensburg, Maryland 20710
    2. Tuesday, October 17 @ 6PM: Tucker Road Ice Rink (Playground in back) | 1770 Tucker Road, Fort Washington, Maryland 20744
    3. Thursday, October 19 @ 6PM: Prince George's County Government Office | 9400 Peppercorn Place, Largo, Maryland 20774

81. Planting List

    Please indicate the number and type of plants you prefer. All efforts will be made to honor your request; however, if quantities are limited or species are not available at the time of planting, adjustments or substitutions may be necessary. Please do not plant tall tress under utility wires - restrict yourself to the smaller trees. Please note that materials are not intended for commercial use.

83. Please indicate ONE option:*

    1. Trees & Shrubs ONLY (Max 10)
    2. Perennials ONLY (Max 20)
    3. Mix (Max 5 trees/shrubs + Max 10 perennials)
    4. If you would like help with plant selection and placement, please indicate here and someone will reach out to you based on the contact info you provided.

85. Assistance for School Sites MUST be requested by September 22, 2023. Assistance for community sites must be submitted by September 29, 2023. Please note that there is limited availability for assistance.

87. 
89. Trees & Shrubs

    Please indicate your selections of trees & shrubs:

    1. 1. American Linden, Tilia americana
    2. 2. Bald Cypress, Taxodium distichium
    3. 3. Sweetbay Magnolia, Magnolia virginiana
    4. 4. White Fringetree, Chionanthus virginicus
    5. 5. Dwarf Fothergilla, Fothergilla gardenii
    6. 6. Black Chokeberry, Aronia meloncarpa
    7. 7. Winterberry, Ilex verticillata
    8. 8. Oakleaf Hydrangea, Hydrangea quercifolia ‘Snow Queen’
90. Please indicate the quantity of each item you want:*

    For example: If you want 2 of #1 and 3 of #5, write 2 of #1 and 3 of #5 in the box above.

92. Perennials

    Please indicate your selections of perennials:

    1. 1. Butterflyweed, Aseclepias tuberosa
    2. 2. Black-eyed Susan, Rudbeckia fulgida
    3. 3. Purple Coneflower, Echinacea purpurea ‘Magnus’
    4. 4. Aster, Aster x ‘Wood’s Purple’
    5. 5. Eastern Bluestar, Amsonia tabernaemontana ‘Storm Cloud’
93. Please indicate the quantity of each item you want:*

    For example: If you want 2 of #1 and 3 of #5, write 2 of #1 and 3 of #5 in the box above.

95. Grasses & Bulbs

    Please indicate your selections of grasses & bulbs:

    1. 1. Little Bluestem, Schizachyrium scoparium ‘Standing Ovation’
    2. 2. Daffodil Mix, Narcissus sp. Mix
96. Please indicate the quantity of each item you want:*

    For example: If you want 2 of #1 and 3 of #5, write 2 of #1 and 3 of #5 in the box above.

100. The completion and signing of this form express our intent to perform under the conditions set forth herein.

102. Signature:*

     By typing your name in this box you are accepting this electronic signature as your written signature.

104. Organization:*
106. Date:*
     Date:

110. For questions related to the Registration Process, please contact:

     Tonya Hairston

     301-499-8641

     GrowingGreenWithPride@co.pg.md.us

Leave This Blank:


112. 1. Receive an email copy of this form.
113. Email address

     This field is not part of the form submission.

114. Submit Submit and Print

* indicates a required field