Adopt-a-Stop Waiver Form

Adopt-a-Stop Waiver Form
Hidden Contact Name

First NameLast Name
Hidden Contact Email
example@example.com
The undersigned Volunteer has reviewed the Safety Rules for GTA’s Adopt-a-Stop Program and agrees to assume all risks in carrying out such activities as associated with this program. The Volunteer agrees to indemnify and save harmless the City from any claims of damages to persons or to property or for death arising out of Volunteer activities carried out pursuant to this Program.
Name of Organization/Group/Business
Please scroll down to the first empty Name field, and complete the Name, Minor (Yes/No) and Signature fields, and repeat for each member of your party. Then click scroll down to the bottom and click Submit Signature(s).

Note: The limit for this form is 20 signatures.

To add more signatures, please contact GTA at 336-412-6309.

Does this form need to be forwarded to other members of your group for additional signatures?

YesNo
How many additional members?
Please list up to 10 email addresses, separated with a comma.
Please separate each email address with a comma.
Please list additional email addresses, up to 10, separated with a comma.
Please separate each email address with a comma.
1. Name
First and Last Name
Is this volunteer a minor?
Signature

Clear
2. Name
First and Last Name
Is this volunteer a minor?
Signature

Clear
3. Name
First and Last Name
Is this volunteer a minor?
Signature

Clear
4. Name
First and Last Name
Is this volunteer a minor?
Signature

Clear
5. Name
First and Last Name
Is this volunteer a minor?
Signature

Clear
6. Name
First and Last Name
Is this volunteer a minor?
Signature

Clear
7. Name
First and Last Name
Is this volunteer a minor?
Signature

Clear
8. Name
First and Last Name
Is this volunteer a minor?
Signature

Clear
9. Name
First and Last Name
Is this volunteer a minor?
Signature

Clear
10. Name
First and Last Name
Is this volunteer a minor?
Signature

Clear
11. Name
First and Last Name
Is this volunteer a minor?
Signature

Clear
12. Name
First and Last Name
Is this volunteer a minor?
Signature

Clear
13. Name
First and Last Name
Is this volunteer a minor?
Signature

Clear
14. Name
First and Last Name
Is this volunteer a minor?
Signature

Clear
15. Name
First and Last Name
Is this volunteer a minor?
Signature

Clear
16. Name
First and Last Name
Is this volunteer a minor?
Signature

Clear
17. Name
First and Last Name
Is this volunteer a minor?
Signature

Clear
18. Name
First and Last Name
Is this volunteer a minor?
Signature

Clear
19. Name
First and Last Name
Is this volunteer a minor?
Signature

Clear
20. Name
First and Last Name
Is this volunteer a minor?
Signature

Clear
Should be Empty: