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2. Name
4. Address
6. Phone Number
7. Organization (If Applicable)
9. Organization Details

   (e.g. membership, scope)

10. Proposed Location
12. Include Map if Possible
13. Letter of Intent

15. Submit application and letter of intent to Barrington Conservation Commission. Applications are reviewed by the Barrington Conservation Commission for recommendation. Applications are then forwarded to the Barrington Town Council for approval.

    The signatory agrees to abide by all Barrington Adopt-a-Spot guidelines. Signatory hereby agrees that the Town of Barrington assumes no liability for personal injuries during activities associated with Adopt-a-Spot program.

17. Name as Signature
18. Date Submitted to Barrington Conservation Commission
    Date Submitted to Barrington Conservation Commission
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20. 1. Receive an email copy of this form.
21. Email address

    This field is not part of the form submission.

22. Submit

* indicates a required field