City of Columbia Adopt-A-Spot Litter Control Volunteer Agreement
The City of Columbia works hard to keep our streets and right of ways free of litter and pollutants. Columbia’s Adopt-A-Spot Litter Program is a great opportunity for volunteers to become a part of the team that makes Columbia a great place to live, work and play while protecting the environment.
First Name *
Your answer
Last Name *
Your answer
Name of Organization *
Name of Group or Individual Adopting
Your answer
Daytime Phone Number *
Your answer
Evening Phone Number
Your answer
Email Address *
Your answer
Mailing Address of Contact Person *
Your answer
Location of Adoption Area *
We can also assist you identifying an area.
Your answer
Name as to appear on sign *
Your answer
Volunteer Program Waiver
As a participant in the Adopt-A-Spot Litter Control Program I understand that I am making a two-year commitment to pick up litter in my assigned area and there is an expectation that I will conduct at least four litter pickups annually. The City will order a sign to recognize my efforts after I have completed my first cleanup and reported back to City staff. At the end of the agreement I will be given an opportunity to renew for another two years.
I hereby agree and represent that I will provide volunteer service under the following terms and conditions:
• I will obey all laws, regulations, and the City Program rules when performing as a volunteer.
• I understand that the City is my supervisor, and I agree to abide by all rules, instructions, and directions of my supervisor.
• I understand and am willing to provide service as a volunteer, not a City employee for purposes of workers compensation or liability coverage, without any compensation for my volunteer service.
• I understand that undertaking volunteer service does not create a contract or any kind of employment relationship with the City.
• I agree that all tools and materials received by the City for volunteer service will be used only on the volunteer task and all tools and unused supplies shall be returned to the City upon completion.
• I will not hold the City liable and hereby waive any claim against that City that may arise out of the performance of volunteer service or any other participation in the volunteer program.
• I understand that it is my responsibility to update any address, phone number, email address or other information on file with the City.
I read and agree with the Volunteer Program Waiver *
Required
Safety Awareness and Precautions
1. Leaders will review safety measures with crew members prior to work. Volunteers are responsible for their own safety.
2. Volunteer Programs will supply safety vests and gloves. Use safety equipment and follow safety precautions at all times.
3. Wear clothes and shoes that are appropriate for work area and the weather. Wear light colored, long-sleeve clothing and a hat.
4. Do not remove any hazardous substance. When in doubt, contact the Volunteer Programs (573) 874-6271
5. Adult supervision is necessary when children are present. A 1:5 adult to child ratio is required with children in line-of-sight.
6. Park vehicles in legal parking spaces off roadside, not on the shoulder. Do not obstruct traffic.
7. Work during daylight hours. Stop working during bad weather.
8. Always face oncoming traffic.
9. Provide water.
10. Avoid overexertion.
11. Use caution when walking on slopes and be alert for holes and obstacles.
12. Be alert for snakes.
13. Stay clear of any construction projects.
14. Seek assistance with heavy lifting.
15. Plan work near roads when there is low traffic volume.
16. Be careful when using a litter stick. Wear leather boots or shoes.

Always be prepared for an emergency
• Every crew should have a first aid kit.
• Have transportation available at all times.
• Know the location of the nearest hospital or emergency room
I Read the Safety Awareness and Precaustions *
Required
I will allow my name to be used for recognition and promotion of the Adopt-A-Spot Program
Submit
Never submit passwords through Google Forms.
This form was created inside of City of Columbia, MO. Report Abuse - Terms of Service