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Adopt-A-Street Program Survey

  1. The City of Coquitlam thanks you very much for your participation in our Adopt-A-Street program. Please take a few minutes to complete this short five minute survey to help us better understand how the program is working and your experiences as a participant.
  2. As an Adopt-A-Street participant, which of the following do you represent?*
  3. Are you an active participant in your Adopt-A-Street location?*
  4. How many members of your organization/group/family currently participate in your Adopt-A-Street location?
  5. On average, how often do you collect in your Adopt-A-Street location?
  6. eg: a small shopping bag full, a large garbage bag full
  7. On average, per month, how many large debris items (furniture, microwaves, construction material etc.) do you encounter?
  8. On average, how often do you collect in your Adopt-A-Street location?
  9. Do you currently use the online Adopt-A-Street Participation Record ( to notify us when you’ve been out collecting and to report dumped debris, graffiti and other potential hazards?
  10. Are you satisfied with your current Adopt-A-Street location?
  11. Will you continue to volunteer until at least October 2021?
  12. Please provide us with your most recent contact information so that we may update our records.
  13. If there is an alternate person we can contact, please enter their information below.
  14. Leave This Blank:

  15. This field is not part of the form submission.