ADOPT-A-BLOCK RENEWAL FORM

Please fill out the below form to participate in the Adopt-A-Block program in 2010!

Blocks that participate will receive the following benefits:

Your block will be scored 3 times between May and October.
You will be eligible to receive free flowers, trees and cleanup supplies.
You will have a reason to engage your neighbors in beautifying the neighborhood.
You will be recognized for your efforts at the Adopt-A-Block Appreciation Dinner.
You will be exposed to creative ideas for block beautification and neighborhood revitalization.

Will you participate in the Adopt-A-Block program in 2010? *

Yes
No

If no, please tell us why.

First Name

Last Name

()

Would you like to receive your block scores via email this year? This will help KIB save time, and paper. *

Yes
No

If yes, please give us your updated e-mail address.

If there is a change in the block you are adopting, please indicate your new block here.

Is there anything else you would like to share with us?