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SHARPS Program Sign-Up Sheet

  1. Please complete the online form below to be placed on the wait-list.
    Rancho Santa Margarita residents are eligible to receive one SHARPS container per month. Please fill out the information below and the City will contact you when a box is available and will set up a date and time for you to come and collect your SHARPs container.
  2. *Please bring ID or verification of residency in the City of Rancho Santa Margarita at pick-up
  3. Contact Information
  4. Additional Information:
    The SHARPS container is a pre-paid postage box. There is paperwork attached to the side of the box in a Ziploc bag that must be filled out before dropping off the filled box at a post office. Rancho Santa Margarita residents CANNOT bring their filled SHARPS disposal box back to City Hall. The SHARPS Disposal container must be scanned/recorded at the treatment facility prior to receiving a new one.
  5. Are you a Resident of Rancho Santa Margarita (Please choose one only)*
  6. Leave This Blank:

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