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ADOPT-A-ROAD Agreement Application

Fishers ADOPT-A-ROAD Agreement Application
Please complete the following information. Please direct all questions to Amy Crell at crella@fishers.in.us or (317)670-9437
Organization:
Phone:
Address:
Contact Person:
Phone:
Address:
Email Address:
Please list the stretch of road you are interested in adopting:
The City will grant requests for specific road segments whenever possible
Please list the approximate number of people participating in each clean-up:
By signing below, the above organization agrees to a commitment of at least one year, and to maintain their stretch of a road once quarterly. Also, by signing below, the above organization acknowledges the potentially hazardous nature of work.
Electronic Signature:
Date:

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