Required fields are marked with asterisks (*)

Adopt a Road Agreement

The Municipality of South Bruce Adopt a Road program has been established as a public service program for volunteers to pick up litter along Municipal Road rights-of-way. It is a way for environmentally conscious citizens, community and civic organizations, private businesses and industry to contribute to a cleaner and more beautiful place to live.

Contact Name/Authorized Group Representative

Name of Group

Phone Number

Email Address

Mailing Address

Postal Code

Township of Road Being Adopted

Proposed Road Being Adopted

Start point of road section being adopted

End point of road section being adopted

Wording for Adopt a Road Signs (sample)

Sample text for adopt a road sign

Please indicate your preferred wording for your sign

I acknowledge it is the volunteer group's responsibility to purchase signs to be placed at each end of the section of adopted road. The cost of these signs (x2) is approximately $100 each plus HST, which is subject to change based on cost from supplier.

Agree

Disagree

I acknowledge that all participants must be at least 12 years of age or older and that there will be one supervisor who is 19 years or older for every five volunteers between the ages of 12 and 18.

Agree

Disagree

I acknowledge that all participants have reviewed and are familiar with the hazardous nature of the volunteer work and the Safety Guidelines before participating in the clean up of the adopted section of the right-of-way.

Agree

Disagree

I acknowledge that all participants under 18 years of age must have signed permission from a parent or guardian.

Agree

Disagree

Disclaimer

Volunteers are not considered as Officers, Employees, or Agents of the Municipality of South Bruce. Any injuries, claims, liabilities, suits, or costs arising from the volunteer activities relating to this program, shall be the sole responsibility of the volunteers. Volunteers shall indemnify the Municipality and agree to abide by the Municipality’s guidelines and to not hold the Municipality responsible for any injuries or damaged that they may cause or suffer as a result of participation in the Adopt-A-Road program.

Date

Signature of Authorized Group Representative

Clear

Form Builder

Adopt a Road Agreement

Wording for Adopt a Road Signs (sample)

Disclaimer