Land Stewards Program Registration

Land Stewards Adoption Program Registration

Step 1 of 3

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I have read and understand the KPB Adoption Program Guidelines(Required)

Yes

I have read and understand the KPB Adoption Program Volunteer Safety Guidelines and viewed the Adoption Program video.(Required)

Safety guidelines available here
View the video here or on the main Land Steward Program page.

Yes

PRIMARY CONTACT INFORMATION

(must be 18 years of age)

Name(Required)

First Last

Organization affiliation (if any)

Title (if applicable)

Address(Required)

Street Address Address Line 2 City State ZIP / Postal Code

Phone (home)(Required)

Phone (work)(Required)

Email(Required)

Enter Email Confirm Email

ROAD AND AREA ADOPTION INFORMATION

Type of area(Required)

Select One

Roadway

Greenway (trail, waterway, pathway, park)

City block

Parking lot

Vacant lot

Community

Other

Name of road/area to be adopted(Required)

Is the road/area safe for volunteers?(Required)

Yes

Name of Municipality(Required)

Name of County(Required)

If the adoption will be in a state park or forest, please list its name.

Please list landmarks identifying the beginning and end points of the adoption.(Required)

Overall length of road, trail or path(Required)

(miles and tenth of miles)

If adoption will be on private property, has written permission been obtained?(Required)

Private roads are not eligible for adoption unless they are open for public use.

Yes

Not on private land

Please upload a permission letter from the property owner.

If unable to upload letter, please email to Stephanie Larson

Max. file size: 128 MB.

ADDITIONAL INFO FOR COMMUNITY ADOPTIONS

This section is only for municipalities who are registering for a community adoption

Are you a representative for a municipality who is registering an adoption for a community?(Required)

Yes

Please upload a letter of support from the local municipality

If unable to upload letter, please email to Stephanie Larson

Max. file size: 128 MB.

Is the community in compliance with Act 101?(Required)

(Communities with over 10,000 residents and densely populated municipalities having between 5,000 and 10,000 residents are required to have recycling programs.)

Yes

KPB Adoption Sign Example
Recognition Sign Example

Sign set includes:

one 30" x 30" Keep Pennsylvania Beautiful Sign
One 24" x 12" sign recognizing the adopters

Do you wish to purchase additional sets of signs?(Required)

KPB provides one set of signs free of charge. Additional sets can be purchased for $133. If additional sets are requested, payment methods will be discussed once adoption location is approved by KPB and the maintainer of the property. Payment must be received before sign order is placed.

Yes

Recognition sign to read:(Required)

KPB may edit adoption sign wording requests, but will work closely with the adopter to agree on final wording.

Location to ship signs:

Signs will be shipped to the municipality for installation.
Please provide the address and name of a contact person.
Signs can not be shipped to a post office box.

Municipal Contact Name(Required)

First Last

Municipal Shipping Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Signature

Signature(Required)

Keep Pennsylvania Beautiful reserves the right to revoke or refuse an adoption.
By typing your name below you are signing the application and verifying that the primary contact is at least 18 years of age. The primary contact agrees to:

Make safety a top priority and review the KPB safety guidelines and adoption video with all adoption cleanup participants.
Assure all cleanup volunteers sign a liability waiver and parental consent forms for participants under the age of 18. Please contact Stephanie Larson for these forms. Completed forms can be uploaded at the time of reporting.
Secure permission to enter if adoption is on private property.
Coordinate two cleanups per year.
Report your results within 2 weeks of each cleanup.
Provide written notice to Keep Pennsylvania Beautiful in the event that he or she wishes to terminate the adoption.
In consideration for the opportunity to engage in volunteer work through PA CleanWays d/b/a Keep Pennsylvania Beautiful (KPB), I agree for myself, my executors, administrators, heirs, successors and assigns to: (A) waive, release or discharge the following persons and entities from any and all liability for death, disability, personal injury, property damage, property theft or actions of any kind which may hereafter occur to me: KPB, its parent and affiliates, their directors, officers, employees, volunteers, representatives, agents, event holders and landowners whose facilities are being used or whose property is being cleaned (collectively the ‘Released Parties’); and (B) indemnify and hold harmless the Released Parties from any and all liability, claims, actions, suits, procedures, costs, damages, fines, penalties and expenses, including but not limited to attorney’s fees, which arise in connection with my participation in the volunteer activities, without limit and whether caused by the acts or omissions of the Released Parties.

Date(Required)

MM slash DD slash YYYY