Adopt-A-Neighbor Application for Help

Adopt-A-Neighbor is a volunteer program administered by the City of Fort Collins Neighborhood Services. This program provides snow removal assistance to Fort Collins residents who: are physically unable to do so themselves; cannot afford to pay for this assistance; or do not already have neighbors, family or friends who can assist them. We do our best to match volunteers with those needing assistance, but cannot guarantee providing a volunteer in every instance. We will do our best to match people, however, if a match cannot be found, applicants are still responsible for proper snow shoveling.

Please submit a completed application and signed release to Neighborhood Services. Contact the Neighborhood Services with any questions.

We will attempt to accommodate this request if possible but cannot guarantee it.

Please fill out the form below and we will be in touch shortly.

Name *This question is required.

Date *This question is required.

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Street Address *This question is required.

City *This question is required.

State *This question is required.

Postal Code *This question is required.

Email Address

Phone Number *This question is required.

Nearest major cross-streets to your home (like Mulberry and College)

Is your house on a corner lot?

Would you like your driveway shoveled?

Statement of Monthly Income
Is your annual income less than $36,000 per year?

Please mark the box indicating your annual income:

Are you physically able to shovel snow?

Do you have a relative or friend who may use as a secondary contact in case we can’t reach you?

Please provide their info below.

Name *This question is required.

Email Address

Phone Number *This question is required.

Do you have neighbors, friends or family to assist you in property maintenance?

RESIDENT CONSENT, RELEASE OF LIABILITY, COVENANT NOT TO SUE, AND HOLD HARMLESS

I hereby request placement as a recipient in the Adopt-A-Neighbor Program ("Program"). I understand that the program is set up to help me meet the City of Fort Collins regulations regarding snow removal. I have read and understand the Recipient Guidelines and understand that I should not invite volunteers into my home or telephone my volunteer at his/her home. I will call the Adopt-A-Neighbor Program at 970-224-6046 with any questions, concerns, or requests.

I hereby release the City of Fort Collins, its officers, employees, volunteers, and agents (collectively, "Releasees") from any and all liability for any and all claims and causes of action which I may hereafter have on account of any and all injuries and damage to me or my property, or loss of any other sort, arising out of or relating to my participation as a recipient in the Program and the services provided to me, or incidental thereto, whether caused by the negligence of the Releasees or any other person. In addition, I covenant and agree not to sue any of the Releasees, and agree to forever hold them and each of them harmless from any liability, claims, demands, actions, or causes of action whatsoever arising from my participation as a recipient in the Program and the services provided to me, whether such liability, claims, demands, or actions are the result of the negligence of the Releasees or any other person. This release of liability, covenant not to sue, hold harmless agreement shall be binding upon me and my heirs, executors, administrators, personal representatives, and assigns, and shall inure to the benefit of the Releasees and their successors and assigns.

Adopt-A-Neighbor Program agreement

By signing this document you will be certifying that you have provided complete and accurate information about your gross annual household income for all household members who will occupy the premises.

I wish to participate in the Adopt-A-Neighbor Program and agree to the enclosed guidelines.

Signature *This question is required.

Date *This question is required.

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Adopt-A-Neighbor Application for Help

Neighborhood Services (970) 224-6046 fcgov.com/neighborhoods

Neighborhood Services
(970) 224-6046
fcgov.com/neighborhoods