Official Site of the City of Phoenix - City of Phoenix Adopt a Street Application & Waiver

Entity Name
Contact Name
	I certify that I am over 18 years old.
Address
City		State	Arizona	Zip
Phone			Email

REQUESTED LANGUAGE for ADOPT A STREET SIGN
(Maximum 14 characters) (Maximum 14 characters)	WHAT LANGUAGE CAN BE PUT ON THE ADOPT A STREET SIGN? There are four options for the language on the Adopt A Street sign: Option 1: The name of the entity. Option 2: The name of an individual. Option 3: The phrase “Friends of …(name)”. Option 4: The phrase “Family of …(name)”. Only two lines of text are permitted with a maximum of fourteen characters per line.

TERMS and CONDITIONS: Initial each line item
Indemnify and hold harmless the City of Phoenix from any claims of damages.
Each person will be required to furnish and wear a safety vest and/or brightly colored clothing.
Minors under the age of 18 must be accompanied by a parent or a responsible adult.
No work will be permitted in the street or median islands.
No work will be permitted beyond daylight hours.
Sidewalks and traffic lanes are to be kept open and unobstructed at all times.
A minimum of four clean-ups per year (at least one every three months) is required.
Contact must be made with Adopt A Street coordinator after each clean-up.
A two year commitment is required.

I have reviewed this application and understand the Adopt A Street Program requirements and agree to the terms and conditions of the program as stated.

Before you submit this email form, we would like you to be aware of the city's policy on the use of its email systems. The policy states that the email message you are about to send: (1) is subject to public disclosure under the Public Records Law, (2) is not private or confidential and (3) is retained for one month.

Official Web Site of the City of Phoenix