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Adopt a Road Questionnaire

  1. Notice
    Do not include any sensitive information on this form or (if applicable) files uploaded to this form. Sensitive information includes, but is not limited to, social security numbers, driver’s license numbers, bank account information, routing numbers, medical information, passport numbers, or passwords.
  2. Do you regularly clean your section of the road?*
  3. Do you wish to continue participating in the Adopt a Road program?*
  4. I need more Adopt a Road trash bags.*
  5. I would like to request additional safety vests.*
  6. If you do not respon and complete this questionnaire your signs will be removed
  7. *If leaving the program you may request to keep one of your signs, if greater than 5 years of service, as a thank you from the Berrien County Road Department.
  8. Leave This Blank:

  9. This field is not part of the form submission.