2. Town of Shady Shores

   Adopt A Spot Program

   101 S. Shady Shores Rd., Shady Shores, TX 76208

   940-498-0044 x 160

   Program Administrator:

    Katie Klein, katie.klein@shady-shores.com

   Program Department: 

   Community Relations

   community.relations@shady-shores.com

3. 
4. 
6. NAME OF ADOPTING GROUP:*

   As to be shown on sign

8. LOCATION*
   Enter the address or a description of the location you wish to adopt.
10. CONTACT*
    Enter the name of the contact person for the group.
12. PHONE*
14. EMAIL ADDRESS*
16. ADDRESS
    Please include City and State
18. OTHER MEMBERS NAMES OF YOUR GROUP
20. NOTE: all members of the group must sign and submit the Certification and Acknowledgement of Risks. Additional signature pages may be found on the Adopt a Spot Page

    https://www.shady-shores.com/1020/ADOPT-A-SPOT

22. Certification and Acknowledgement of Risks*

    1. I have read the below and agree to the terms stated

    I hereby certify that all statements made in this application are true and correct to the best of my knowledge, and I authorize the investigation of all matters contained in the application or data pertinent to my volunteering. 

    I acknowledge that any false statements or misrepresentation on this application will be cause for refusal of placement or immediate dismissal. 

    I understand and agree that in the performance of voluntary services,
    
    I am not a Town of Shady Shores employee and shall have no rights to wages or benefits and no promise, expressed or implied of consideration for future employment. 

    I agree and to indemnify and hold the Town of Shdays shores employees and contractors harmless from any and all liability for any injury that I might incur arising out of or in any way connected to my participation in this program. 

    I also agree to grant full permission to the Town of Shady Shores to use my name and any photographs, video or recordings for any purpose whatsoever without any obligation, liability, or compensation to me. 

    Volunteers are not covered under the Town of Shady Shores Workers Compensation Plan. Therefore it is recommended volunteers have their own medical insurance coverage. If a serious incident occurred, a legal claim can be presented and an investigation into negligence will take place. For more information refer to the Town of Shady Shores. 

    
    

24. New in 2023, Shady Shores is a partner with Trash Free Texas.

    1. By clicking this box, You do NOT wish to have your name submitted to Trash Free Texas.

    As part of our partnership with Trash Free Texas, the town submits the adopted location and name of the adopter on the https://www.trashfreetexas.org/.

    
    

26. CHECK ONE

    1. Adopting a spot (community garden, community green spaceparks, vacant lots, lake front, wetlands water ways)
    2. Adopting a Street (Streets include right-of ways for any city owned streets or unpaved streets)
    3. Our Group will take What is Available- areas the town has determined in need of care
28. Signature
30. DATE
32. Upload Map, Group Picture or other files as needed
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field