Adopt-a-Stream Application

2. Guidelines & Other Forms
   Adopt-a-Stream Guidelines & Forms (PDF)

   Before submitting this online application, please review this document containing program guidelines, checklists, and other forms needed in the process.

3. City of Alcoa Program Contact
   Andrew Sonner, P.E.<br>725 Universal St<br>Alcoa, TN 37701<br>Phone: 865-380-4806<br>Fax: 865-380-4803<br>Email: asonner@cityofalcoa-tn.gov

   Andrew Sonner, P.E.
   725 Universal St
   Alcoa, TN 37701
   Phone: 865-380-4806
   Fax: 865-380-4803
   Email: asonner@cityofalcoa-tn.gov

4. 

8. Applicant Name(s)*

10. Stream Name*

11. Miles of Stream to Be Adopted*

13. Name of Adopting Organization

14. Number of Stream Cleanups Per Year

    (Two Required)

18. Designated Representative (Primary)*

19. Phone Number*

21. Street Address*

23. City*

24. State*

25. Zip Code*

29. Designated Representative (Secondary)*

30. Phone Number*

32. Street Address*

34. City*

35. State*

36. Zip Code*

40. Designated Representative Agreement*

    1. I have read, understand and shall comply with the Adopt-A-Stream general program conditions and safety guidelines.

    The work will be performed under and in accordance with the General Program Conditions and Safety Guidelines both attached to this application and incorporated herein by reference.
    
    Applications to whom an Adopt-A-Stream Program Designation and Agreement are issued shall at all times indemnify and save harmless the City of Alcoa, and all employees, agents and officers, from responsibility, damage, or liability arising from the exercise of the privileges granted under designated programs. The Program Designation and Agreement may be terminated by the City of Alcoa at any time. The City of Alcoa reserves the right to revise or discontinue the Adopt-A-Stream Program at any time.
    
    As a designated representative I have read, understand and shall comply with the Adopt-A-Stream general program conditions and safety guidelines regarding participation in the program.

42. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
44. Electronic Signature*

45. Date*
    Date

Leave This Blank:


47. 1. Receive an email copy of this form.
48. Email address

    This field is not part of the form submission.

49. Submit Submit and Print

* indicates a required field