Adoption Agreement

Group Information

Group Name*
Our Group is a*
Most of us are*

Group Point of Contact

Contact Name*
Email*
Primary Phone*
Street Address
City
Group Website

Street You Want to Adopt

City of Adopted Street*
Street Name*
Exact Start and Stop of Adopted Street Reach (e.g., From Hwy T bridge to Bancroft Intersection)*
Plans for first cleanup (Day/Month/Year)*
Number of Group Volunteers

The Adopt A Street Commitment

Required*

By checking this box, I agree, on behalf of my group, to the Adopt A Street Commitment:

As an Adopt a Street member, we promise to do the following:

  • Adopt at least one mile of public roadway for a two-year period.
  • Complete at least four cleanups per year.
  • Abide by the Adopt A Street Program Guidelines and Safety Guidelines.
  • Ensure all volunteers in my Group complete the liability release form prior to engaging in cleanup activities.
  • Conduct myself in a professional manner so that my actions do not affect negatively on my Team, other Adopt a Street Teams, the Adopt a Street program or the City of West Des Moines and Metro Waste Authority as a whole.
  • Respect the property rights of private landowners and always ask permission before entering private land.
  • Report my Group’s cleanup results so that our efforts can be included with all other Adopt a Street member activities to show that we are making a difference.
  • I agree to indemnify and hold harmless the Adopt a Street sponsors, officer, agents, and assigns from any and all liability for claims, demands, and actions from any and all volunteer activities in which I or my group may participate.