The Rhode Island Department of Transportation will work with the adopting group to determine the specific section of roadway to be adopted. Limited access multi-line divided highways, interstates, and areas, which lack sufficiently wide right-of-way, are prohibited from being adopted. List highway section, in order of preference, that you are interested in adopting including City/Town, road name and route number, and termini description.
1. RTE # OR ROAD NAME: We agree that work will
be performed under and in accordance with the Rhode Island
Department of Transportation's "Adopt-A-Highway" conditions attached to this
application and incorporated herein by reference.
We further agree that if
our application
is approved, each participating member of our organization,
for themselves shall at all times indemnify and save harmless RIDOT and RIDOT
employees,
agents and officers, from responsibility, damage or liability
arising from the exercise of the privileges granted in such applications.
We further agree that this application may be terminated
by RIDOT at any time RIDOT determines that, under this program is unsafe
or causes
a
conflict with traffic. The Department reserves the right to
revise or discontinue this program at any time.
| FIRST NAME: | LAST NAME: |
| ORGANIZATION: | |
| ADDRESS: | |
| HOME PHONE: | WORK PHONE: |
| EMAIL: | |
| NAME TO APPEAR ON SIGN: (Limit 28 letters/spaces) | |
Occasionally we receive calls from reporters or citizens requesting information about groups participating in Adopt-A-Highway. If someone calls about your group, would your like your phone number released?
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APPLICANT SIGNATURE____________________________DATE________
ADOPT-A-HIGHWAY ADMINISTRATOR_________________DATE________
I, a member of the __________________________________, have received and read the roadside safety training information as a prerequisite to participation in the Adopt-A-Highway Program. I do hereby release and discharge the State of Rhode Island, the Rhode Island Department of Transportation, and their officers, agents and employees, from all claims, demands and causes of action of every kind whatsoever for any damages and, or, injuries which may result from my participation in the Adopt-A-Highway and other voluntary activities on or near the highway right-of-way. I further agree to hold harmless the state of Rhode Island, the Rhode Island Department of Transportation, and their officers, agents and employees, from liability for any damages or injuries resulting from any acts or failure to act on my part during participation in said voluntary activities on or near the highway right-of-way. |
| SIGNATURE | ADDRESS |
| ________________ | ____________________________ |
| ________________ | ____________________________ |
| ________________ | ____________________________ |
| ________________ | ____________________________ |
| ________________ | ____________________________ |
| ________________ | ____________________________ |
| ________________ | ____________________________ |
| ________________ | ____________________________ |
| ________________ | ____________________________ |
| ________________ | ____________________________ |
| ________________ | ____________________________ |
I, a member of the __________________________________, have received and read the roadside safety training information as a prerequisite to participation in the Adopt-A-Highway Program. I do hereby release and discharge the State of Rhode Island, the Rhode Island Department of Transportation, and their officers, agents and employees, from all claims, demands and causes of action of every kind whatsoever for any damages and, or, injuries which may result from my participation in the Adopt-A-Highway and other voluntary activities on or near the highway right-of-way. |
Parents please sign and return this sheet to the school/organization with your child.