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Adopt-A-Street Application

  1. ADOPTING GROUP CONTACT INFORMATION
  2. Please type exactly as to be displayed on street sign.
  3. I understand that during my participation in the Adopt-A-Street Program, I am subject to the rules and regulations of the Village’s Public Works Division. I do hereby agree to release, indemnify and hold harmless the Village of Clemmons, its agents, officers and employees and volunteers from any and all claims, liabilities, demands, damages, actions or causes of action of any kind or character (including, without limitation, attorney's fees, costs and expenses) that may arise in any manner by reason of death, injury, damage to my person or property or both as a result of my participation in the Adopt-A-Street Program. By submitting this form, I agree to abide by all of the program guidelines.*
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