Registration Form
Empire Township
ADOPT-A-PARK/TRAIL
PROGRAM APPLICATION
Organization Name:____________________________________________
Contact Person:________________________________________
Contact Address______________________________________________________________
_________________________________________________________________
Contact Phone Number:___(____)_______________________________
Contact Email Address:__________________@_________________._______
Number of Persons in Group:_____________________
Park Preference, if any:________________________________________________________
Statement of Agreement:
I have read and agree to abide by the policies and regulations as designed by
Name:_________________________
Date:___________________________
Adoption Information (FOR OFFICE USE ONLY) Assigned Park:________________________________ Location:___________________________ Adoption Dates: From_______________ To:______________