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Application for City of Waukegan Adopt-a-Road Progrem

  1. GROUP INFORMATION
  2. Type of Group*
  3. Type of Application*
  4. Adult Supervision

    If participants are under 18 years old, adult supervision is required, with an average of one adult per seven individuals under 18 years old.   Will your group be able to supply an adequate number of adults per cleanup?

  5. We will have adequate adults for supervise cleanup.*
  6. WHAT WILL APPEAR ON SIGNAGE
  7. Name/Acronym will appear on the sign.  No logos or slogans will be allowed. Program Director may request modification to the name that will be printed on the signs.  Limit will be 17 characters per line, two lines.  Leave spaces between words.

  8. ROAD SELECTIONS
  9. First Choice - Section of Roadway to be adopted
  10. Include the cross streets at both ends of the road your group is adopting.  For example, "Washington Street to Grand Avenue."

  11. Second Choice - Section of Roadway to be adopted
  12. Include the cross streets at both ends of the road your group is adopting.  For example, "Washington to Grand Avenue."

  13. SIGNATURE

    I hereby certify that the above information is correct and my Group/Organization agrees to conform to the requirements of the City of Waukegan Adopt-a-Road program as outlined below in Ordinance 22-O-26.

  14. I read and agree to conform to the Ordinance.*
  15. Leave This Blank:

  16. This field is not part of the form submission.