Form Center

Step One

2. Name*
3. Email Address*
5. Address*
7. City*
8. State*
9. Zip Code*
11. Phone Number*
13. Tree Size*

    1. Large
    2. Small
    3. Need Help

    *Tree size and availability is subject to change based on what is available from the nursery. If you do not know what size, the program partner will help determine that for you.

14. Aerial*

    Submit and Aerial of Your Property *marked up with the desired location of the planting of the tree/s.

16. Appointment Time Preference*
    Appointment Time Preference

    Appointment Time Preference

    Preference of Time for Consultation. *Note a Representative will contact you to coordinate an appropriate time scheduled for your planting after the initial consultation. It may take up to two week or more to get you scheduled due to 811 dig and availability of crew for the actual planting.

18. Continue

Waiver or Liability

2. Indemnification

   INDEMNITY/HOLD HARMLESS AGREEMENT NEIGHBOR-GROW Program

   This indemnity/hold harmless agreement is dated upon acceptance of agreement and submission of application between property owner and the city and it's partners of the "NEIGHBOR-GROW Program"

   WHEREAS, Indemnitor has requested planting of a tree on their private property or on a public right-of-way adjacent to Indemnitor’s property for the purpose of increasing tree canopy in East Chicago. 

   NOW, THEREFORE, in consideration of receipt of submission and permission from the City (if on city right-of-way) to plant appropriate tree/s with Indemnitor’s plans, Indemnitor agrees that it will indemnify the City, its officials, agents, program partners, representatives and employees from, against, or for all losses, claims, actions, costs and expenses (including, but not limited to, court costs, attorney’s fees and expert witness fees), judgments, subrogations, or other damages ( collectively “Claims”) resulting from any injury to a person or persons or to property, arising out of Indemnitor’s participation of program, for which Indemnitor, in whole or in part, or anyone for whose acts Indemnitor may be liable, is liable. 

   This agreement shall not be assigned without written approval of both the Indemnitor and City. INDEMNITOR (corporation/entity): 

4. First Name*
5. Last Name*
7. Acceptance*

   1. Accept
8. Date*
   Date
10. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
12. Electronic Signature*
Leave This Blank:


13. 1. Receive an email copy of this form.
14. Email address

    This field is not part of the form submission.

15. Submit Submit and Print | Go Back

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