Form Center

2. Douglas County Adopt-A-Road
   

   Adopt-A-Road Application

   
   

   
   

   
   

4. NAME OF VOLUNTEER GROUP*
6. MAILING ADDRESS*
8. CITY*
9. STATE*
10. ZIP CODE*
12. LIST THE SECTION(S) OF COUNTY ROAD YOU ARE INTERESTED IN ADOPTING IN ORDER OF PREFERENCE:
14. *EXAMPLE*

    EASTMONT AVEUNE                                     FROM GRANT ROAD                                               TO 19TH STREET

16. FIRST CHOICE*

    ROAD NAME

17. FIRST CHOICE AREA*

    FROM ROAD                                                                           TO ROAD

19. SECOND CHOICE*

    ROAD NAME

20. SECOND CHOICE AREA*

    FROM ROAD                                                                           TO ROAD

22. THIRD CHOICE*

    ROAD NAME

23. THIRD CHOICE AREA*

    FROM ROAD                                                                           TO ROAD

25. Sections of a County road are assigned on a safety and first-come, first-serve basis. The County will conduct a traffic safety review before assigning a section. If the section(s) your group has identified above is not available or suitable for adoption, DOUGLAS COUNTY SOLID WASTE PROGRAM will assist your group in identifying alternative road sections.

    DOUGLAS COUNTY SOLID WASTE PROGRAM will assist your group in identifying alternative road sections.

    WARNING! PLEASE READ CAREFULLY. Participants in the Adopt-A-Road Program are advised that working adjacent to any road is a DANGEROUS ACTIVITY. Risks associated with this activity include, but are not limited to, serious injury or death. Each participant is further advised that the risk of harm is present even if all safety precautions are followed.

27. 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.
29. Electronic Signature*

    Signature of Volunteer Group Representative

31. FIRST, LAST NAME*
32. DAY PHONE*
34. MAILING ADDRESS*
36. EMAIL ADDRESS
37. CITY*
38. STATE*
40. ZIP CODE*
Leave This Blank:


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

    This field is not part of the form submission.

44. Submit

* indicates a required field