Adopt A Park & Public Areas Interest Form

Community organization or business name (required):

Organization/business postal mailing address:

City State Zip Code

Lead project coordinator name:

Phone number:
Work: Home: Cell:

Email Address:
Work: Personal:

Alternate coordinator name:

Phone Number:
Work: Home: Cell:

Email Address:
Work: Personal:

Park, street or public area the group would like to adopt (or nearest intersection/crossroads for matching
group with the nearest appropriate location):

Preferred project date (or start date for permanent projects):

Please mark type of litter cleanup project: Ongoing/permanent (at least monthly)One-time

Estimated # of participants:

Age range of participants:

Volunteers under 18 require adult supervision and they are not allowed on streets with speed limits above 25 mph.

Note: Tucson Clean & Beautiful, the City of Tucson, and Pima County are not responsible for injuries or
damages sustained as a result of volunteer participation in Adopt-a-Park and Public Areas program activities.

By typing my name here and pressing submit, I agree to the above liability waiver/age restriction and to follow all program protocols.

Organization/business representative signature:

Date:

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