Adopt a Street Registration Form

Please ensure to read the Adopt a Street Program Guide before submitting your application.
Contact Information:(Required)
Address:(Required)
Email Address(Required)

Emergency Contact:

Contact Information:(Required)

Preferred Adoption Location

In the field below, note your first choice, then second choice for the street you’d like to adopt.
Please be as detailed as possible, in terms of street names, location, number of blocks and whether you wish to adopt one or both sides of the street. List your first choice, then second choice below:
Please be as detailed as possible, in terms of street names, location, number of blocks and whether you wish to adopt one or both sides of the street. List your first choice, then second choice below:
 

Contact our Adopt a Street Coordinator Michelle Nalleweg

phone: 604-469-9877   email: michelle.nalleweg@anmore.com

Risk, Waiver and Idemnity Agreement

By signing this Agreement, you waive certain legal rights, including the right to sue. Please read carefully
Adopt a Street Program Requirements(Required)
Awareness and Assumption of Risk(Required)
Waiver of Claims, Release of Liability and Indemnity Agreement(Required)
I have read and agree to comply with the Terms and Conditions listed under the Risk, Waiver, and Idemnity Agreement section. I recognize that by signing this document I am waiving certain legal rights, including the right to sue.
MM slash DD slash YYYY

Witness Information

Name
Address of Witness
MM slash DD slash YYYY
Personal information requested on this form is collected under the authority of Section 26 of the Freedom of Information and Protection of Privacy Act, as amended. The information gathered will be used to deliver or evaluate the program or activity of the Village of Anmore that is associated with this form. Questions about the collection, use, and disclosure of this information should be directed to village.hall@anmore.com