Adopt-A-Street Application Form

Adopt-A-Street Application Form

Please enter all required information, thank you.
The City of Prescott's Adopt-A-Street Program is envisioned as a community stewardship initiative that brings residents, businesses, organizations, neighborhood groups, and other community partners together to help maintain and beautify Prescott's streets and public rights-of-way.
Street Segment
Example: Meadowridge Rd (See Map)
Would you like your adoption (select one):
Name of Individual/Organization/Group
Primary Contact

First NameLast Name
Primary Contact Email Address
example@example.com
Primary Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Primary Contact Address
Please tell us about yourself/organization/group and why you are applying
Hold Harmless Agreement

The Participant or where the Participant is a minor, his/her parent or guardian, shall indemnify, defend, and save harmless, the City of Prescott, hereinafter referred to as "City," from any and all clams, demands, suits, actions, proceedings, loss, cost, and/or litigation expenses, which may be brought or made against or incurred by the City on account of loss of or damage to any property or for injuries or death of any person, including the applicant, caused by, or arising out of, or contributed to, in whole or in part, by reasons of any act, omisson, error, fault, mistake or negligence of Participant, its agents or representatives, in connection with or incident to the performance of this Agreement, or arising out of Workers' Compensation claims, Unemployment Compensation claims, Unemployment Disability Compensation claims or claims under similiar such laws and obligations.
Is Applicant/Participant 18 years of age or older?
Hold Harmless Agreement Acknowledgement
*I acknowledge that I have read and understand the above agreement as written.
Front & Back of Valid Driver's License

Cancelof
Should be Empty: