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2. Adopt A Spot Program Application
   Thank you for your interest in adopting a spot in the city of Coalinga. All applicants approval is at the sole discretion of the City of Coalinga. Please fill out this application to begin the process. Once reviewed, a formal application will be submitted for you to review and sign.
4. First Name*
5. Last Name*
7. Email Address*
9. Address*
11. City*
12. State*
13. Zip Code*
15. Phone Number*
17. Adopted Spot Information*
    Please describe the spot that you wish to adopt and what activities you plan on accomplishing.
19. Minors*

    Will any minors be involved in the cleaning of your adopted spot?

    1. Yes
    2. No
23. If any minors will be involved, please provide contact information for their parent/guardian. This is needed to sign the final agreement.
25. Number of Minors
    -- Select One --123

    Please provide the number of minors that will be involved. If the minors are from the same family, please count them as one.
27. Name(s) of Minor
28. Name of Parent/Guardian
30. Phone Number
31. Email Address
33. Name(s) of Minor
34. Name of Parent/Guardian
36. Phone Number
37. Email Address
39. Name(s) of Minor
40. Name of Parent/Guardian
42. Phone Number
43. Email Address
47. Once Approved
    Once you submission has been approved, you will receive an email from "Adobe Sign". Please fill out this document entirely. Note: This email may be in your junk or spam inbox.
Leave This Blank:


49. 1. Receive an email copy of this form.
50. Email address

    This field is not part of the form submission.

51. Submit

* indicates a required field