Herbicide Exemption Petition Initiator Application Form

This application form will begin the petition process to discontinue the use of herbicide applications for weed control at a green space in your neighbourhood. In order to petition a particular green space the location of the proposed site must be submitted to the City’s pesticide use exemption program coordinator for review. This review ensures that the site you are proposing to petition is eligible for petitioning. After reviewing the site’s eligibility the program coordinator will contact you with the results. At that time, you may collect signatures using the official petition form. 

The petition will only be considered valid after a confirmation of eligibility to petition the site.

Please be aware that the initiator of the petition must adhere to the following Program Guidelines:

1. Read and accept the Terms and Conditions
2. Be available for a period of one year to answer public inquiries resulting from the petition
3. Use the official petition form provided by the City
4. Submit the following form to the program coordinator by either filling out and submitting the online form below or by mailing a hardcopy of the initiator form to:

Pesticide Use Exemption Program Coordinator
City of Edmonton, Community Services
Neighbourhoods, Parks and Community Recreation
12th floor, CN Tower, 10004-104 Ave, Edmonton
P.O. Box 2359
T5J 2R7

Contact Information

Salutation

MrMrsMs

First name:

Last name:

Home phone:

Work phone:

Fax:

Email:

Site Address:

Postal Code:

Mailing Address (if different than above):

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Confirmation

Date 

By checking this box I acknowledge that I have read and agree to the Program Guidelines, Terms and Conditions and the information submitted is true and correct.

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FOIP Statement

This personal information is being collected under the authority of section 33(c) of the Freedom of Information and Protection of Privacy (FOIP) Act. The City of Edmonton will use this information for purposes necessary to and consistent with determining the discontinuation of herbicide applications on the petitioned site. The privacy provision of the FOIP Act protects all personal information collected by the City of Edmonton. If you have any questions regarding the collection or use of this information, please contact Parks program coordinator at 780-423-1465.

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