Rain Barrel Donation Request Form

Date of request______

Rain Barrel Donation Request Form

(If you need more room please submit supplementary sheets, do not leave out information)

Buffalo Niagara RIVERKEEPER’s priority sites are: high visibility sites such as key public buildings, government offices, community gardens, schools and education centers in low income communities within the Buffalo and Niagara River watershed. Organizations that service multiple sites are invited to apply for those multiple sites.

To be eligible, you must have an external gutter system with a downspout to divert into the rain barrel!

Name: ______Title: ______

Organization: ______

Address: ______City______, State_____ Zip______

Phone: (_____) ______- ______

Email: ______

Fax: (_____) ______- ______

Address or location of Barrel (if different from above):

Street ______

City ______, State ______Zip______

What is the mission of the organization? Please explain how you serve the community. Please describe the community that you serve.

What purpose will the rain barrel serve at your facility?

How many people will be educated about the rain barrel at your site annually? ______

How many people visityour site annually? ______

Describe the visibility of rain barrel. (For example, is it within street view or hidden in the back of the building. Will it be a focal point in your garden?)

Who owns the building where the barrel will be installed?

Is the location a nonprofit, school or university, public building?

How many barrels would you like to request? (Up to two barrels per site) ______

Do you have an external gutter with a downspout? (Circle One) Yes No

Would you like a Downspout Diverter? (Circle One) Yes No

(If you do not have a downspout, you may not be able to collect the rainwater)

What size Diverter would you need? (Circle One) 2”x3” 3”x4”

Size roof area will be draining into rain barrel (square feet)? ______

Do you have someone to install and maintain the barrel? (Circle One) Yes No

Name ______

Title ______

Experience ______

How do you plan to use the water? ______

If for a garden:

Is it a rain garden? (Circle One)

Yes No No, But I would like more information on RainGardens

Are you using native plants? (Circle One)

Yes No No, But I would like more information on Native Plants

Who will be responsible for tending to the garden and using the barrel?

Name ______

Title ______

Experience ______

Do you need your Rain Barrel(s) delivered? (Circle One) Yes No

What color to you prefer? (Circle One) Green Gray Brown

(Buffalo Niagara RIVERKEEPER cannot guarantee color availability.)

Workshops:

Workshops are in the process of being scheduled. If you are interested in hosting one or attending pleasecontactAdrienne Kina, , 852-7483 ex. 19

Diverters, that make seasonal changes easier, are also available upon request.

Next steps: Once approved, an appointment will be made with you to set up a site visit and to deliver the barrel, if needed.

If approved, before you receive your Rain Barrel, you must agree to and sign the maintenance agreement, no exceptions will be made.

Please submit your requests online at or return this application form to:

Buffalo Niagara RIVERKEEPER

Rain Barrel Donation Program

1250 Niagara St

Buffalo, NY14213.

For questions or more information, please contact Kerri Bentkowski at (716) 852-RIVER or email