Form Center

2. Hampton Clean City Commission
3. ADOPT-A-SPOT AGREEMENT
4. Adopting Group Name*
6. In order to enhance the environment and the appearance of our community, we, the undersigned, request permission to Adopt-A-Spot/Street at the following location (boundary and/or address description):
8. Adopt-A-Spot Location*
   Please be specific in describing the location, using boundaries, cross streets, addresses, and/or other descriptors.
10. Said work will be performed under and in accordance with the City of Hampton's Clean City Commission terms attached hereto and incorporated herein by reference.
12. Program Description & Guidelines
    Adopt-A-Spot Program Description & Guidelines

    Please review before completing contract.
14. Applicants with whom agreements are signed shall at all times save harmless the City of Hampton and Clean City Commission employees, agents, and officials, from responsibility, damage, or liability arising from the exercise of the privileges granted under this agreement.
15. This agreement may be terminated by the City of Hampton at any time if the applicants are unable to comply with this agreement or at any time the applicant's work is considered unsafe. The City reserves the right to revise or discontinue this program at any time.
17. GROUP CONTACT INFORMATION:
19. Name & Title*
21. Email Address*
22. Physical Address*
    Street Number and Name, City, and Zip Code
23. Phone Number(s)*
    Please include area code
24. ELECTRONIC SIGNATURE OF APPLICANT*
    By signing this contract, you are making commitment in the same way you would with a written signature.
26. OFFICE USE ONLY
27. The undersigned is the owner, agent, government official or representative who has the legal authority to hereby give permission for the property location named in the aforesaid agreement to be involved in and designated in the Adopt-A-Spot/Street program as administered by the City of Hampton and the Hampton Clean City Commission.
29. Permission is hereby given to perform the work described, insofar as the Clean City Commission has the right, power, and authority under this agreement.
31. Coordinator's Electronic Signature
33. Date
34. Comments / Notes:
Leave This Blank:


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

    This field is not part of the form submission.

38. Submit

* indicates a required field