Adopt-A-Neighbor Volunteer Application

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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 help; and do not have immediate neighbors, family or friends to assist them.

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

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

Name *This question is required.

Date

Calendar

Street Address *This question is required.

City *This question is required.

State *This question is required.

Postal Code *This question is required.

Phone Number

Phone Number (Work)

Email Address

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

Are you under 18 years? *This question is required.

May we contact you at work?

In addition to the sidewalk and a path to the front door, are you willing to shovel the driveway?

Do you have your own snow shovel?

Participation Options:

I would like to be matched with a resident in need for the entire snow season.
I would like to be an on-call, back-up volunteer, as needed.

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

I hereby request placement in the Adopt-A-Neighbor Program ("Program"). I understand that by participating in the Program, I am not, nor shall I represent myself to be a volunteer or employee of the City of Fort Collins. My participation in the Program may include, without limitation, the following risks and hazards: physical exertion in shoveling snow and ice resulting in bodily injury or death, slipping and falling on snow and ice, tripping over objects or obstructions, suffering frostbite or dehydration. I am aware of the risks and hazards inherent in my participation in the Program, and recognizing those risks and hazards, I hereby consent to and request participation in the Program. I acknowledge that I have read and understand the Volunteer Guidelines.

I hereby release the City, 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 due to 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 in the Program, 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 in the Program, 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

I certify that the above statements are true and agree to follow all program guidelines.

Signature *This question is required.

Date *This question is required.

Calendar

If the volunteer is under the age of 18, his or her parent or legal guardian must also sign:

I am the parent or legal guardian of the volunteer who has signed above. I have read and understand the provisions of this document. I consent to the volunteer participating in the Program described above, and I fully enter into and agree to the above volunteer consent, release of liability, covenant not to sue, and hold harmless agreement.

Signature of Parent or Legal Guardian

Date

Calendar