Neighborhood Cleanup Program Form

Step 1 of 3

Requestor's name * Required
First Last
Requestor's Email * Required
Requestor's phone number * Required
Type of Association or Organization * Required
Name of Neighborhood Association/ Mobile Home Park/ Home Owner Association * Required
Have you reached out to your authorized neighborhood association representative or HOA/mobile home park leader? * Required
If yes, please enter the representative's name
First Last
Representative's email
Representative's phone number

1st Preferred date * Required
A minimum of three weeks’ notice before desired date is required
MM
DD
YYYY
2nd Preferred date
MM
DD
YYYY
Are you open to receiving the container(s) the day before your scheduled event?
Container quantity * Required
1st Container address * Required
Street Address Address Line 2 City State ZIP Code
2nd Container address (optional)
Street Address Address Line 2 City State ZIP Code
3rd Container address (optional)
Street Address Address Line 2 City State ZIP Code
4th Container address (optional)
Street Address Address Line 2 City State ZIP Code
5th Container address (optional)
Street Address Address Line 2 City State ZIP Code
Flyers to be picked up or mailed: * Required
- Pick-up - Flyers may be picked up from City Hall
- Mail-in - Please mail to the address below
How many flyers will you need? * Required
A digital flyer of your event will be provided to you when your cleanup is confirmed. Up to 50 printed flyers may also be requested per scheduled container.
Mail-in address * Required
Street Address Address Line 2 ZIP Code

By signing below, I agree and will follow through with the Neighborhood Cleanup program guidelines below:
1. This program is only available at no cost to neighborhood groups and private non-commercial organizations that wish to conduct a neighborhood cleanup with a residential area in the City of Santa Ana
2. Neighborhood cleanup containers are to be shared by the neighborhood and not for sole personal use by one or a few residents
3. If I am not the authorized neighborhood association representative or HOA/mobile home park leader, I understand that the City will not finalize this reservation until the appropriate leaders are in agreement of such event
4. Confirmed events will be promoted to the neighborhood, HOA, or mobile home park at least three weeks in advance
5. As the organizer of this cleanup, I will monitor or recruit volunteers to help monitor all containers at all times to avoid hazardous and/or illegal dumping on the day of the cleanup
6. As the organizer of this cleanup, I will be responsible for the containers from the day they are delivered to the day they are removed. Should any issues arise, I will contact City staff immediately. (City contact phone numbers will be provided to all organizers prior to the event)
By typing my name in the Signature field below,
- I agree that my electronic signature is the legal equivalent of my manual/handwritten signature and I consent to be legally bound to this agreement.
Signature of Neighborhood Cleanup Program requester: * Required
Date * Required
Month
Day
Year
CAPTCHA