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Adopt a block - request form

Adopt a Block registration form

1. You must agree that you are aware that you will be voluntarily engaging in an activity that may involve certain risks and dangers, including, but not limited to, picking up sharp or hazardous objects, and working in proximity to moving vehicles. *This question is required.
2. I want to adopt a block as: *This question is required.
For example: (1900 block W 4th)
This question requires a valid email address.
10. How did you hear about our program? *This question is required.