Form Center

2. Name of Organization, Group, Club, Family, or Business Affiliation:*
4. Name to Appear on the Sign:*
6. Road Segment ID:*
   -- Select One --N LEGACY DR ID-123COUNTY ROAD 134 ID-28COUNTY ROAD 134 ID-17COUNTY ROAD 97 ID-18E G.A. MOORE PKWY ID-27SETTLERS RIDGE RD ID-38LYNN STAMBAUGH PKWY ID-26W SUNSET BLVD ID-12E SUNSET BLVD ID-25E SUNSET BLVD ID-29W GLENDENNING PKWY ID-24W PUNK CARTER PKWY ID-3W PUNK CARTER PKWY ID-36HUDDLESTON DR ID-4HUDDLESTON DR ID-37W OUTER LOOP ID-14W OUTER LOOP ID-33E OUTER LOOP ID-22CHOATE PKWY ID-21CHOATE PKWY ID-31CHOATE PKWY ID-32KINSHIP PKWY ID-5PUNK CARTER PKWY ID-30PUNK CARTER PKWY ID-6S COIT RD ID-19S DALLAS PKWY ID-126S DALLAS PKWY ID-129S DALLAS PKWY ID-78S DALLAS PKWY ID-41S DALLAS PKWY ID-125S DALLAS PKWY ID-128JOHN CAMPBELL TRL ID-1E OWNSBY PKWY ID-11VEST LN ID-23WELLS RD ID-13ROSELAND PKWY ID-9TWIN EAGLES DR ID-7WATERVIEW TRL ID-8DOE BRANCH BLVD ID-2W FRONTIER PKWY ID-39CRUTCHFIELD RD ID-20BOTHWELL BLVD ID-10

   View Map to see available streets. Only GREEN segments are adoptable. 

7. 
8. View Map
   ADOPT-A-STREET MAP
10. Team Leader's First Name*
11. Team Leader's Last Name*
13. Team Leader's Email Address*
14. Team Leader's Phone Number*
16. Address (Proof of Celina Residency/Celina Business)*
18. Any Questions/Comments/Concerns:
20. Application Agreement & Safety Information

    Build community pride and involvement by getting your group together to adopt a City of Celina Street! Volunteering to clean litter provides a visible impact to the environment by preventing pollution and does wonders for the overall beautification of our city and its roadways. This opportunity is open to teams of all kinds: families, clubs, co-workers, and civic organizations. Volunteer and become an active participant involved in keeping Celina a beautiful Life Connected community.

    CLICK HERE TO REVIEW THE APPLICATION & AGREEMENT SAFETY INFORMATION

22. Check Box:*

    1. I understand and agree to the terms of the Adopt-A-Street Application Agreement & Safety Information
24. Liability Waiver

    In consideration of the City of Celina’s acceptance of my participation in the above project, I, for myself, participating in the project, any heirs, executors, administrators and assigns, forever releases and discharges any and all rights, demands, claims and causes of suit of action, known or unknown, whether arising now or in the future, that I may have against the City of Celina and any and all injuries, including death and property damage in any manner arising or resulting from my participation in said project, that I solely assume those risks, that I will, without limitation, assume and pay any medical and emergency expenses in the event of an accident, injury, illness, or other incapacity, regardless of whether I have authorized such expenses. Furthermore, I state that I have carefully read this release, know the contents of the release, and have signed this release on my own free will.

    CLICK HERE TO REVIEW THE LIABILITY WAIVER

26. Check Box:*

    1. I understand and agree to the terms of the Liability Waiver
Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

* indicates a required field