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2. Adopt-A-Spot Signage Application Form
4. Application Checklist*

   1. Have you completed at least 6 months of active participation in the Adopt-A-Spot program?
   2. Have you conducted a minimum of two (2) documented cleanup events within 6 months of your adoption date?
   3. Have you submitted a completed event report after every cleanup event?
6. Name of Applicant*

   (Individual or Group)

7. Email Address*
9. Contact Person:

   (if applicable)

10. Phone Number*
12. Name of Adopted Spot*
13. Original Adopt-A-Spot Adoption Date*
    Original Adopt-A-Spot Adoption Date
15. Number of Cleanup Events Conducted (Since Adoption Date)*
17. Dates of the Last Two Cleanup Events:
19. Event 1*
    Event 1
20. Event 2*
    Event 2
24. Signage Request

    Please briefly describe why you would like to have a sign installed at your adopted location (optional)

26. Additional Information

    Please attach any relevant documentation to support your application, such as photos from cleanup events

28. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
30. Electronic Signature
Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

* indicates a required field