Clone of Adopt-A-Road Program Application

Adopt-A-Park Program Application

Keep Polk County Beautiful, Inc., Polk County Government and the City of Winter Haven will work with the adopting group/individual to determine if the specific Park is available for Adoption.
Name of interested Organization, Business, Group or Individual :
President, Chairperson, Etc.:

First NameLast Name
Contact Name:*

First NameLast Name
Contact Mailing Address:*

Street Address

Street Address Line 2

CityFlorida

Postal / Zip Code
E-mail:*
Home Number:

Area CodePhone Number
Cellular Number:*

Area CodePhone Number
Work Number:

Area CodePhone Number
Organization/ Business Website:
Anticipated number of members participating in the program:
Park section(s) you are interested in adopting
Please list the City in which the interested park is in. You may list multiple parks.
Signature

Clear
Signature date
Should be Empty:

Adopt-A-Park Program Application