Adopt-a-Stream Application

Adopt-a-Stream Application

City of Greensboro Water Resources
Thank you for your interest in the City of Greensboro's Adopt-a-Stream program! This initiative allows volunteers to take an active role in protecting our natural resources, improving water quality, and enhancing stream habitats. The program also fosters community involvement and raises awareness about the importance of our City’s water resources.

Anyone who submits a form should be aware that in accordance with the North Carolina Public Records law, found in North Carolina General Statutes Chapter 132, their e-mail address is considered public record.
YesNo

- Safety Guidelines for Adopt-a-Stream Program
  - Must be 10 years of age to participate, with proper supervision by an adult and parental/guardian signature.
  - Stream cleanup should only be done during daylight hours.
  - Conduct a safety meeting for all participants prior to each volunteer activity.
  - Wear light-colored clothing that covers arms and legs. Also wear rubber boots or waders, gloves, hat and safety glasses.
  - Wear clothing that will not impair vision or movement during these cleanup activities.
  - Work in small groups. Do not work alone!
  - Stay clear of any construction.
  - Do not work in inclement weather.
  - During warm weather months, drink plenty of fluids, take breaks, and avoid overexertion.
  - During cold weather months, dress warmly with layered clothing.
  - Be alert for snakes, stinging insects, poisonous plants, etc.
  - Carpool to the site to reduce the number of vehicles.
  - Use proper bending and lifting techniques.
  - Be aware of wet rocks, hills, and slopes. Watch your step!
  - Do not use or possess illegal drugs or alcohol while participating in volunteer activities.
  - Do not pick up trash or walk on bridges, on overpasses or in tunnels or culverts.
  - Do not pick up what appears to be hazardous materials - notify your volunteer coordinator if you encounter hazardous objects or holes, guy wires and other hidden obstacles in the ground.
  - Do not attempt to squeeze bags to make room for more trash (injuries from broken or jagged objects can result from this practice).
  In Case of Emergency
  - Have an adequate first-aid kit available.
  - Prior to volunteer service, select an emergency room/hospital and know the route from the work area to the designated treatment facility.
  - If possible, have at least one member bring a cell phone for emergencies.
  Bag Pickup Procedure
  - Group the bags and large debris together in a practical location not in the sidewalk. Please place them at least 8 feet from the side of the road to make the job of collecting bags easier and safer for City staff.
  - Record the location of the orange bags on the Cleanup Reporting Form, and include a picture of the bags (if able).
  Print a copy of Safety Guidelines PDF

Group Contact and Volunteer Information
Name of Group/Organization*
Number of Volunteers in the Group*
If the exact number is unknown, please provide an approximate number.
List your group/organization's social media account(s), if any.
Follow us @GSOGoesGreen to see upcoming events and campaigns!
PRIMARY CONTACT INFORMATION
Primary Name*

First NameLast Name
Primary Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number*
Format: (000) 000-0000.
Primary Email*
example@example.com
SECONDARY CONTACT INFORMATION
Secondary Name*

First NameLast Name
Secondary Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Secondary Phone Number*
Format: (000) 000-0000.
Secondary Email*
example@example.com
Stream Cleanup Information
When providing stream cleanup location information, it is very important to be very specific and provide as many details as possible.

Examples of location details
- Street name: example, Horse Pen Creek Rd., near Quaker Run Rd.
- Intersection: Intersection of Horse Pen Creek Rd. and Battleground Rd.
- Corner: The corner of Horsepen Creek Rd. and Drawbridge Pkwy.
Stream Cleanup Location(s)*

To verify the location(s) listed above, we are asking for a screenshot of each location.

Capture a screenshot

Click: Adopt-a-Stream Map Link
Find and zoom to the general location of the desired stream including neighboring streets.
Take a screenshot of the map and save it.
You will be asked to upload the screenshot(s) within this form.

YesI don't know how to do that
Upload your screenshot(s) of your location(s) *

Cancelof

Member Obligations and Adopt-a-Stream Sign Request
I. REQUIRED ITEMS

The following items are necessary to fulfill membership obligations for the Adopt-a-Stream program
- Two stream cleanups each year for two years
  - Completed Event Notification Form preceding each cleanup
  - Completed Waiver Forms from all participants preceding each cleanup
  - Completed Cleanup Reporting Form following each cleanup
II. ADOPT-A-STREAM SIGN REQUEST FORM

The City of Greensboro Stormwater Management Division may cancel this agreement if the above-named participant fails to meet its collection obligations for its adopted section of a stream. Participants will be notified in writing prior to canceling of this agreement, which may include, if applicable, the removal of signs. The City of Greensboro Stormwater Management Division reserves the right to revise or discontinue the Adopt-a Stream Program at any time.

Each volunteer group is entitled to an Adopt-a-Stream sign, within City limits, along a street that crosses the stream or other designated location. Sign will not be installed until two cleanups have been completed, and all necessary documents are returned.

Below you have the option of two lines with the possibility of up to 16 characters per line (punctuation marks count as one letter). If the name of your organization can fit on one line, the sign maker will use a larger character for better visibility.

Please include only the name of your group or organization. Phrases such as "In Memory of" or "In Honor of" will not be allowed on the Adopt-a-Stream signs. The Adopt-a- Stream Coordinator must approve all signs.
First Line
You may use up to 16 characters. Punctuation marks count as one letter.
Second Line
You may use up to 16 characters. Punctuation marks count as one letter.
Signature*
Date*

MonthDayYear
Date

Waiver of Liability / Certificate of Participation Form
WAIVER OF LIABILITY / CERTIFICATE OF PARTICIPATION FORM*
I, {primaryName}, understand that participating in the program listed below involves risk of injury. These risks may include effects of inclement weather, accidents, contacts with or actions of other participants, or slips/trips/falls, among others. I choose for myself or for my child to participate in the program despite the risks.

By signing below, I acknowledge all risks, and I assume all responsibility of injury, illness or death in any way connected to the program. I acknowledge that I am not covered by any City of Greensboro insurance policy. In return for the opportunity to participate in the program, I agree for myself or my child and for my heirs, assigns, executors, and administrators to release, acquit, waive, and forever discharge any legal rights I may have to seek payment or relief of any kind from the City of Greensboro, its officers, employees, agents, or its volunteers for injury, illness, death, or property loss resulting from participation in the program.

I also agree not to sue the City of Greensboro, its officers, employees, agents, or its volunteers and to indemnify and save harmless the City of Greensboro, its officers, employees, agents, or its volunteers against all claims, actions, lawsuits and demands, including reasonable attorney fees, made by anyone for any damages, losses or injuries of any kind, including environmental, which may result from participation in the program. Permission is given for any emergency medical treatment which might become necessary, and I agree to be responsible for the expense of medical treatment or service.

If I am registering a child for the program, I agree that I am a parent, legal guardian, or am otherwise responsible for the child, and that I release waive, and discharge any legal rights that I may request on behalf of the child participant.

Image Release: I hereby consent to allow the exclusive use of, and relinquish all rights to, photographs, recordings, and reproductions in any manner of the likeness, voice, and/or activities of the participant and further authorize the City of Greensboro, its agents or assigns, to make unlimited use of such reproductions, including but not limited to print and/or electronically, broadcasting of the reproduction over radio, television, or on the internet with or without a name for any lawful purpose. I acknowledge that no compensation will be provided for such use by the City.

I understand this release shall remain in effect unless a subsequent written notification is provided by the City.
Signature*
- Date*
  
  MonthDayYear
  Date
- Should be Empty:

Adopt-a-Stream Application

Group Contact and Volunteer Information

Stream Cleanup Information

Member Obligations and Adopt-a-Stream Sign Request

Waiver of Liability / Certificate of Participation Form