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Adopt-A-Street Program Agreement

Adopt-A-Street Program Agreement
The Town of Huntersville recognizes the need and petition for litter-free streets and sidewalks. The Adopt-A-Street program has been established to address this need and enable residents, community and civic organizations, or religious and social groups to contribute toward our town beautification efforts.
Participants have the choice of two levels of adoption commitments: “Major” and “Minor.”
Major adoptions include the adoption of town maintained streets that are at least 0.25 miles in length and approved by the Town to include the adoption provisions of safety vests, gloves, trash bags and a road sign identifying you or your group as the adopter of the street.
Minor adoptions include the adoption of town maintained streets that are at least 0.25 miles in length and are not approved by the town to include adoption provisions, due to the minimal amount of potential clean up required. Participants must provide their own safety and clean up equipment for minor adoptions.
The Town will collect all bags of trash for BOTH Major and Minor adoptions. See Appendix A for approved street names and lengths.
After one year of service, an organization may adopt more than one street as long as the combined lengths do not exceed two (2) miles. Contact the Town Coordinator for authorization.
Appendix A
AAS Street List
Appendix B
AAS Safety Guidelines
AAS Safety Guidelines
By completing and signing this form, you are agreeing to the following terms:
 One to three year commitment to cleaning up your chosen street(s)
 All participants shall be at least 12 years of age; participants between the ages of 12 and 17 must have adequate supervision by one or more adults 21 years of age or older
 Litter pick up at least 4 times per year (quarterly) starting from the date of approval
 Acceptance and adherence to the Safety Guidelines (Page 4)
 Notification of the Town Coordinator prior to and upon completion of each quarterly collection
 The Town is not responsible for any injuries or damage experienced as a result of participation in the adoption program
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Street Information

The Town of Huntersville recognizes*
(Name of Organization, or Individual)
as the adopting organization for the following street(s):
Street Name*
Intersection Street One*
From Intersection Street One
Intersection Street Two*
To Intersection Street Two
Street Name
Intersection Street One
From Intersection Street One
Intersection Street Two
To Intersection Street Tow
Street Name
Intersection Street One
From Intersection Street One
Intersection Street Two
To Intersection Street Two
Length of Adoption*
Choose one of the following
1. One Year
1. Two Years
1. Three Years
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Contact Information

First Name*
Last Name*
Address*
City*
State*
Zip Code*
Email Address*
Phone Number
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.
Electronic Signature*
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Adopting Organization Information

In the space provided below, print the name of your non-profit organization as it should be displayed on the street sign. If the adoption is “In Memory of” or “In Honor of”, please include such wording in your title. Names of companies or businesses are not permitted.*
All participants must sign the attached document verifying that they agree and will comply with the terms listed within the Adopt-A-Street Program Agreement. Any participants between the ages of 12 and 17 must have a parent or guardian sign for their participation.
Participant Signatures
AAS Participant Signature Page
AAS Safety Guidelines
AAS Safety Guidelines

Leave This Blank:

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

This field is not part of the form submission.
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