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2. Adopt-A-Drain Program Interest Form

4. Please complete this application if you are interested in participating in the City of St. Pete Beach Adopt-A-Drain Program. This program requires you to watch an online educational training video and complete additional volunteer and consent forms prior to receiving materials to maintain the stormdrain(s) you adopt. Once this application is submitted, City of St. Pete Beach team member will contact you to provide additional instructions. Thank you for your interest in helping to keep our waters clean.

6. First Name*
7. Last Name*
9. Phone Number
10. Email Address*
12. Cell Phone Number*
14. Address*
16. City*
17. State*
18. Zip Code*
20. How would you prefer to receive notifications and reminders about cleaning out your adopted drain? *

    1. Email
    2. Home Phone
    3. Cell Phone
    4. Text Message (Standard messaging rates will apply)
    5. I do not want to receive any notifications or reminders
22. How many adults (18 or older) will be helping you maintain your drain? *
24. Are there any other considerations we should be aware of? *
26. How did you hear about this program? *

    1. Facebook
    2. Word of Mouth
    3. Email
    4. Posted Flyer
    5. Web Search
    6. Nextdoor
    7. Keep Pinellas Beautiful
28. Please read through the requirements here
    Adopt-A-Drain Requirements
30. I have read through the program requirements provided in detail on the City of St. Pete Beach Adopt-a-Drain page. *

    1. Yes
32. I hereby irrevocably consent to, and authorize, the use and reproduction of any and all videotaped and photographic recordings taken of me and /or my child/children, my property (i.e., music, art, photography, home, vehicle, etc.) for use in not-for-profit public education television productions and print media by the City of St. Pete Beach. I understand that this will be done without compensation to me and all recordings or images shall become the property of the City of St. Pete Beach*

    1. Yes
    2. No

34. E-mail addresses are public records under Florida law and are not exempt from public-records requirements.

    If you do not want your e-mail address to be subject to being released pursuant to a public-records request, do not send electronic mail to this entity.

    Instead, contact this office in writing, via the United States Postal Service to this address:

     

    City of St. Pete Beach

    Attn: PIO Sarah Laracuente- Adopt-A-Drain

    155 Corey Ave.

    St. Pete Beach, FL 33706

Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field