Form Center

2. Application to Participate
4. Contact Info
6. Individual / Organization / Business Name*
8. Address1*
10. City*
11. State*
12. Zip
14. Primary Contact/ Adopt-A-Street Captain*
15. Title
17. Phone Number*
18. Email*
20. Alternate Contact
21. Phone Number*
22. Email*
24. Volunteer Info
26. Number of Adult Volunteers*
27. Number of Volunteers Under the Age of 18*
29. Block, Street, or Site of Adoption: Beginning and ending point (cross streets)*
31. Block, Street, or Site of Adoption: Beginning and ending point (cross streets) if first is unavailable
35. Signature *

    By typing your name you are certifying that the undersigned agrees that all work will be done in accordance with the City of Hemet’s Adopt-A-Street Program rules and regulations and will be subject to inspection and approval. The Adopt-A-Street Program and its courtesy signs are not a forum for advertisement or public discourse.

    
    

Leave This Blank:


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

    This field is not part of the form submission.

39. Submit

* indicates a required field