Driveway Access Snow Removal Form

Driveway Access Snow Removal Program
Program Renewal Request

This online registration is for returning registrants qualifying for the program because they are 62 years of age or older only. This online renewal request will be processed ONLY if a signed release form is already on file.

If this is the first time you are applying, or you wish to renew your registration due to a medical condition, please see our main Driveway Access Snow Removal Program page.

Applicant Name: *

Address: *

Zip Code: *

Subdivision: *

Home Phone: *

Cell Phone:

Work Phone:

Email Address: *

Preferred Method of Contact: *

EmailPostal Mail

I understand this is a voluntary program that I am electing to participate in. By selecting “I hereby agree” below, I am renewing the release on file with my program application, which holds the City of St. Peters harmless for any damage to my property as a result of driveway access snow removal operations.

Release Statement: *

I hereby agreeI hereby disagree

<strong><span style="font-size: 12pt;">In lieu of your handwritten signature, by typing your name in the box below, you are agreeing to the above:</span></strong>

Signature: *

City of St. Peters, Missouri - My Hometown