2023 CLEAN DRAINS FORT WAYNE
SIGN UP TO MARK STORM DRAINS IN YOUR AREA
The Name of Your Business or Organization (if applicable)
Your Phone Number
Please enter a valid phone number.
ADDRESS FOR DRAIN MARKING KIT DELIVERY (these will be left on your porch or by your front door).
Street Address Line 2
Postal / Zip Code
Please share the number of storm drains you intend to mark:
More information about drain marking can be found on the website:
Please indicate when you intend to COMPLETE drain marking (optional):
WAIVER & CONSENT TO PARTICIPATE
By checking this box, you acknowledge and agree you are participating in the 2022 Clean Drains Program (“Program”) on a voluntary basis and your participation may involve risks inherent to the activities being undertaken in connection with the Program. You acknowledge that you knowingly and willingly accept such risks and that the City of Fort Wayne and Friends of the Rivers shall have no liability related to your participation in the Program whatsoever. By checking this box, you agree to release, discharge, and hold harmless the City of Fort Wayne and Friends of the Rivers, and each of their respective employees, agents, and representatives, of and from all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating to your participation in the Program, whether as a result of bodily injury, property damage, or death. You further acknowledge that this release includes any claims, actions, damages, costs or expenses based on the actions, omissions, or negligence of the City of Fort Wayne and Friends of the Rivers, and each of their respective employees, agents, and representatives.
For more information contact Irene Walters at firstname.lastname@example.org.
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