2. Adopt A Park Interest Form
   If you are interested in helping out with Coon Rapids' parks, one of our 4 programs in the Adopt-A-Park program may be just for you!
4. Name of Group/Organization (if applicable, otherwise just fill out the name section of this form):*
6. First Name*
7. Last Name*
9. Address1*
11. City*
12. State*
13. Zip*
15. Primary Phone Number*
16. Email Address*
17. If you have a desired park in mind, please list the park name here:
19. Please check which park programs are of interest to you:*

    1. Adopt-A-Park (pickup litter 3 times per year for 2 years minimum)
    2. Pick-A-Park (pickup litter 1 time per year)
    3. Sponsor-A-Park (provide ongoing financial and/or labor and/or real property support for development and maintenance of a park)
    4. General Park Project (specific one-time improvement - financial, labor or real property)
21. What park would you like to work in?
23. When groups help with one of our 4 park programs, we acknowledge the organization with a thank you sign in the park. Please provide the name of the organization or person to appear on the sign.*
24. How did you hear about this program?*

    1. City Website
    2. Web Search
    3. Facebook

    1. City Newsletter
    2. City Parks & Recreation Book
    3. Other
26. Would you like your group or organization name to be mentioned in the Coon Rapids Connection City Newsletter in recognition of your involvement with the Adopt-A-Park program?

    1. Yes
    2. No
28. If you answered yes, please describe how your group should be mentioned (provide name and brief summary of the group's mission).
30. The City of Coon Rapids reserves the right to refuse, cancel, or revise, this agreement if in its sole judgment the nature of the group or its symbol is political, controversial, or in questionable taste, or if the group is not meeting the terms and conditions of this agreement. By signing this agreement, the group acknowledges the hazardous nature of the work and agrees to comply with the terms and conditions herewith to the satisfaction of the City of Coon Rapids. The volunteers or their agents shall assume all liability for, save and defend the City of Coon Rapids, its agents and employees, harmless from any and all claims for damages, actions, or causes of action arising out of the work to be done herein, whether brought by a volunteer or a 3rd party. Any and all volunteers of the group, or other persons while engaged in the performance of any work or service performed under this agreement, shall not be considered employees of the City of Coon Rapids, and any and all claims that may or might arise under the Workers' Compensation Act of Minnesota on behalf of said employees or other persons while so engaged, and any and all claims made by any third party of the group's volunteers or other persons while so engaged on any of the work or services to be rendered, shall in no way be the obligation or responsibility of the City of Coon Rapids. I understand that I am required to abide by all rules and regulations set forth by the City of Coon Rapids. I also understand that I have the right to receive a copy of this acknowledgement should I request one.
32. Signature of Applicant*
33. Date*
35. Next Steps:
    After you submit this online form, the Parks Supervisor will call you within 7-10 days to discuss further details about the project you have chosen.
    Once all details have been discussed, your organization can move forward with helping out in the city park system. Be sure to read the Safety Tips Sheet, download the Workers List and read the Terms and Conditions Sheet, located on the previous web page http://www.coonrapidsmn.gov/1151/Adopt-A-Park-Program
    We appreciate your interest in serving Coon Rapids through the Adopt-A-Park program!
Leave This Blank:


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

    This field is not part of the form submission.

39. Submit Submit and Print

* indicates a required field