City of Regina | Adopt a Greenspace Application Form

Contact Information

Name of Organization or Individual*

Organization Contact Name

Address*

Postal Code*

Home Phone*

Work Phone

Email*

Number of Volunteers Participating*

Do you or any member of your group have a medical problem that we should be aware of? If yes, please describe.

Emergency Contact Name*

Relationship*

Contact Number*

I would like to adopt the following location(s)*

I would like to perform the following tasks*

Description of tasks:*

How often will you carry out these tasks?

Start Date

End Date

Agreements are renewed on an annual basis.

Confirmation*

All fields marked with an asterisk (*) are mandatory.