Adopt-A-Street Application

2. Organization Name*
4. Contact First Name*
5. Contact Last Name*
7. Contact Phone*
8. Contact Email Adress*
10. Organization Mailng Address*
11. STE/APT
13. City*
14. State*
15. Zip*
17. Number of Participants*
    -- Select One --1357910+
18. Number of Clean-ups Per Year (Minimum of 2)
    -- Select One --23456+
20. Available Street Sections*
    -- Select One --Mill Road South to White Pine RoadCTH C to Mission RoadOakwood Drive to Hwy PMission Road to east city limitsMission Road to Nashotah Village LimitsCTH C to cul-de-sac

    Please select the street section your group would like to in the box above.
22. VOLUNTEER AGREEMENT AND RELEASE WAIVER
    Volunteer Agreement and Release Waiver

    All participants MUST have a Volunteer Agreement and Release Waiver on file with the City of Delafield. Download the Waiver form by clicking the link above.
24. Volunteer Agreement Release and Waiver Form *
    Upload volunteer waiver forms here. Waivers are REQUIRED for each participant.
26. Terms and Conditions*

    1. By submitting this form, I have read and understand the terms and conditions of this application and will adhere to the rules and regulations set forth by the City of Delafield.
28. TERMS AND CONDITIONS
    Adopt-A-Street Terms and Conditions
30. City of Delafield Adopt-A-Street Clean-Up Report
    Adopt-A-Street Clean-Up Report

    Please submit a Clean-Up report after each clean-up has been completed. Follow the link above to be directed to the Clean-Up Report form.
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