Form Center

2. Your First Name
3. Your Last Name
5. Your Address
7. Phone*

   Contact phone number required

8. Email address*

   Contact email address required

10. City
11. State
12. Zip
15. Catch Basin Address (approximate)
17. Volunteer Agreement
    • Inspect the catch basin at least monthly to determine if it needs debris removal.
    • Inspect again and remove debris before any anticipated storm event.
    • Submit proof of maintenance when drain is clear by emailing before and after photos to adoptacatchbasin@hollywoodfl.org
    • Always wear the proper protective equipment and take these safety measures:
      1. Never attempt to clean any storm grates DURING a storm event.
      2. Inspect and clear catch basins only during the daytime.
      3. Clear top of drains using rakes or brooms.  Bag debris for disposal with scheduled trash pick-ups.
      4. Adopt only drains next to the curb.  Clear from the curbside, not out in the street.
      5. Watch out for traffic.  Don’t clear catch basins that are in the middle of a street.
      6. Be careful of standing water to avoid slipping or stepping on sharp objects.
      7. If children are helping, make sure adults are supervising.
      8. Don’t try to lift storm drain grates.  They are very heavy.
19. Terms and Conditions

    Participant agrees to relieve, hold harmless and indemnify the City of Hollywood, its agents, servants, and employees, from any and all actions, claims, injuries, damage, costs or expense, and lawsuits arising out of any act, action, neglect, or omission in furtherance of activities connected with the Adopt-A-Catch Basin Program.

    For other questions please call: 954.921.3414

21. Agree and Submit*

    1. adoptacatchbasin@hollywoodfl.org

    By clicking I agree to the above agreement, and terms and conditions.

Leave This Blank:


23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit

* indicates a required field