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Adopt-a-Park Program: Environmental Clean-ups Location Agreement Form

Town of Whitby Community and Marketing Services Department
500 Victoria Street West, Whitby, ON L1N 9G4
Phone: 905-430-4310 Fax: 905-668-5933
Email: parks.rec@whitby.ca Web: www.whitby.ca

This Location Agreement Form is used by the Adopt-a-Park Program: Environmental Clean-up to request a Park or Open Space to be adopted. This form must be completed and signed by the AGR in order to be evaluated by the Supervisor of Community and Marketing Services Department, Parks Development Division or an authorized designate.

Authorized Group Representative (AGR) Information:

First Name

Last Name

Phone Number

Email Address

Organization/Individual/Group Name

Address

Park or Open Space requested (please upload a map):

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Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Projected start date (month and year):

Number of years to Adopt-a-Park (minimum 3 years):

How many times will you participate in the program annually? (minimum of three times):

Number of people participating (approximately):

Are you a first time participant?

Yes

Adopt-a-Park renewal?

Yes

No clean-ups on the following Holidays:
New Year’s Day, Family Day, Good Friday, Victoria Day, Canada Day, Civic Holiday, Labour Day, Thanksgiving Day, Christmas Day and Boxing Day.

By initialing below and submitting this form, I confirm that I have read the Terms and Conditions and the Agreement associated with the Program and understand the nature of the work that will be performed.

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Adopt-a-Park Program: Environmental Clean-ups Location Agreement Form

Authorized Group Representative (AGR) Information: