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Application Form and Terms and Conditions

** = Required Fields

Please enter your general information:
** Contact Name:
Organization Name:
Please enter your contact information:
Address:
City:
State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip/Postal Code:
** Daytime Phone Number:
** E-Mail Address:
	I do not have an e-mail address.
** Location of Shelter You Would Like to Adopt (cross streets, landmarks, etc.):
What Would You Like to Have Printed on Your "Adopted By..." Sign?:
(subject to approval)

By submitting this application, Volunteer agrees to the Terms and Conditions stated below.

Terms and Conditions

In consideration of Pace providing an "Adopted by..." sign at the adopted shelter, promoting the Volunteer’s participation in the Adopt-A-Shelter program, providing a squeegee, broom, and route schedules/timetables for the shelter, Volunteer agrees as follows:

• Volunteer will remove litter at the adopted shelter at least once per month.
  
• Volunteer will clean the shelter including washing of shelter panels at least once per month.
  
• Volunteer will ensure that an up-to-date schedule for the route(s) passing this shelter is present.
  
• Volunteer will promptly remove graffiti if possible or will notify Pace’s Adopt-A-Shelter coordinator if graffiti cannot be removed by cleaning.
  
• Volunteer will report shelter vandalism to Pace’s Adopt-A-Shelter coordinator.
  
• Volunteer will maintain a monthly maintenance log and submit it to the Pace Adopt-a-Shelter coordinator on a monthly basis (10-Ride passes will not be mailed until a maintenance log is received).
  

• Affix the shelter with a semi-permanent sign acknowledging adoption of the shelter by Volunteer (upon Pace approval).
  
• Provide one 10-Ride ticket per month, which allows five free round-trips per month on Pace service (upon receiving a completed monthly maintenance log).
  

Volunteer shall be responsible for complying with any and all applicable state and local parking and driving regulations when traveling to and from and being at the shelter as a part of his or her participation in the Adopt-a-Shelter program.

Volunteer agrees that this Agreement shall be effective from the date signed by Pace and continue until terminated by either party. Pace reserves the right to terminate this Agreement for any reason at any time.

Volunteer agrees that Pace may temporarily suspend this Agreement because of construction near the site or any other reason shelter may be inaccessible.

Volunteer agrees to contact Pace’s Adopt-A-Shelter coordinator if Volunteer will be unable to maintain the shelter for any period of time (e.g. vacation, relocation, illness).

Volunteer agrees that if this Agreement is terminated by Pace for failure or neglect to properly maintain the shelter, Volunteer will not be allowed to participate in the Adopt-A-Shelter program for a minimum of six months following termination.

Volunteer shall contact Pace’s Adopt-A-Shelter coordinator at 847-228-2321 to request trash liners, repair or replacement of trash receptacle, and/or repair or replacement of "Adopted by..." sign. If there are any other questions or concerns related to the shelter, Volunteer is expected to contact the Adopt-A-Shelter coordinator.

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