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Adopt-a-Road application form

The City of Waterloo’s Adopt-a-Road program is for organizations or community groups to adopt an approved section of roadway and remove litter a minimum twice per year, usually spring and fall. For each cleanup, 5 - 10 adult group participants are required.

The Group Leaders schedule, coordinate, monitor and reports on all litter clean-up activities as indicated by their signature on the Adopt-a-Road Agreement. A Group Leader must be registered, screened and officially accepted as a City of Waterloo volunteer and receive a mandatory orientation session, prior to performance of the task.

To initiate your project request, read and understand the Adopt-a-Road program guide and Volunteer Position Description, followed by completion of the application form below.

I have read and understand the Adopt-a-Road program guide & Volunteer Position Description

Agree

Disagree

Organization name or group

Type of organization:

Comments

# of years this organization been active

Organization's website or Facebook page

Group leader #1

Phone number

Email address

Group leader #2

Phone number

E-mail address

Name of adoptable road

Intersecting roads at the start and end of adopted road section

Preferred date of 1st clean-up

Personal information requested on this form is collected under the authority of the Municipal Act, 2001, S.O. 2001, c. 25, and will be used by the City of Waterloo for initiating an Adopt-A-Road project on an approved roadway in Waterloo. Questions regarding this collection should be directed to City of Waterloo @ 519-886-2310.

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