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2. Thank you for your participation in the Adopt-a-Highway program. Please submit a separate report for each pickup date.
4. Click here to obtain a permit application. You will be given a permit number once approved.
   Caroline County Adopt-a-Highway Permit Application
6. Permit Number*
   Visit https://co.caroline.va.us/DocumentCenter/View/4621/Caroline-County-Adopt-a-Highway-Application-PDF to obtain a permit application. You will be given a permit number once approved
8. Group Name
10. Email Address*
12. Pickup Date*
    Pickup Date
14. Number of Participants
16. Work Hours
    Hours x Participants
18. Number of Trash Bags
20. Items Found
    -- Select One --Beer and Soft Drink CansPlastic/Styrofoam/Fast Food ContainersGlass ContainersRubber ItemsCigarettes/Tobacco ProductsNewspapers/MagazinesAll of the AboveOther
22. Unusual Items Found
24. Comments
Leave This Blank:


25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field