Adopt-A-Highway Application

If you need help completing this form, please contact the coordinator for your county.

Fields marked with an asterisk (*) are required.

Group Information

Group Name

Mailing Address Line 1

Mailing Address Line 2

City

State

Zip

Primary Contact

Primary Contact First and Last Name

Mailing Address Line 1

Mailing Address Line 2

City

State

Zip

Primary Phone Number

Alternate Phone Number

Email Address

Acknowledgement Sign

Group Name as it should appear on the sign (up to 3 lines with 12 space maximum on each). Contact information, directions, slogans, emails, phone numbers, text numbers and web addresses are not allowed to be on the acknowledgement sign. Installation of signs takes approximately 90 days from the order of the signs.

Line 1

Line 2

Line 3

Select Site

County

First Choice

Second Choice

Third Choice

Submit Form

I/Group have read the Terms and Conditions and agree to them.

I/Group have viewed the Safety Video.

By submitting this form, the Group acknowledges the hazardous nature of the work and agrees to the terms and conditions stated on the page attached to this form. The Group understands there are no fees for participating in the program. This permit is valid until such time the Group notifies the Department of abandonment of their segment.

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