Adopt-A-Purpose Forms
Updated: December 9, 2019
Please fill in the necessary information in the following documents and submit one copy.
Please print it out and bring it to the counter.
Note: Please print on plain paper and print size A4.
Thermal paper for thermal printers cannot be accepted.
Application form
Adaptation system application form (style 3 from style 1) (PDF: 69KB)
Adaptation system application form (form 1 to form 3) (Word: 53KB)
If there are changes
If there is a change in the activity location, participants, content, etc., please submit a change notification form to the city. After submission, we can change agreement contents after discussion with city.
Change notification form (Form 5) (PDF: 43KB)
Change notification form (Form 5) (Word: 34KB)
When to stop an activity
If you wish to cease your activities, please submit a cancellation request form to the city. After submission, you can cancel your agreement with the city.
Note: When canceling the agreement, please restore the management location to its current state.
Cancellation application form (Form 7) (PDF: 46KB)
Cancellation Request Form (Form 7) (Word: 34KB)
activity report
After starting your activities, please write down the activity status for one year in an activity report and submit it to the city by the end of May every year.
Activity report (Form 9) (PDF: 51KB)
Activity Report (Form 9) (Word: 35KB)
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Inquiries regarding this page
Inagi City Urban Environment Development Department Green and Environment Division
2111 Higashi-Naganuma, Inagi-shi, Tokyo
Phone: 042-378-2111 Fax: 042-378-9719