Adopt-A-Hand Sanitizer Interest Form Help stop the spread of COVID-19 in our community! The City of Alexandria, in conjunction with the Alexandria Health Department, is seeking community partners to host and/or adopt City-owned hand sanitizer stations for public use. Community partners can fill one of two roles: sanitizer station hosts who place a hand sanitizer station at their business, organization, or facility site; or sanitizer station adopters who monitor and care for a hand sanitizer station on nearby public property (e.g. park, street corner, transit facility).Host/Adopter Expectations Fund hand sanitizer fluid refills (estimated cost of $50-$100 per month) Periodically inspect the hand sanitizer station, reporting its condition to the City Refill the hand sanitizer fluid as needed Make the hand sanitizer station available for use at your site (hosts only) Host/Adopter Benefits Help our community continue to safely remain open, by providing an important infection prevention measure Include your logo on the hand sanitizer station that you host or adopt Use of a City-funded hand sanitizer dispenser at your site (hosts only). Note: the dispenser will be this unit or similar. If you have any questions about the program, or if you need assistance filling out the interest form, please contact sarah.popelka@alexandriava.gov. Question Title * 1. Business/Organization Name Question Title * 2. Business/Organization Type (check all that apply) Multifamily Residential Community Organization Congregate Living Setting Prepared Meal Distribution Site Place of Worship Business Business Association Homeowners Association Neighborhood Association (e.g. Civic Association, PTA) Other Question Title * 3. Address (or Location) Question Title * 4. Contact Name Question Title * 5. Contact Phone Number Question Title * 6. Contact Email Question Title * 7. Which of the following are you interested in? Hosting a hand sanitizer at your site Adopting a hand sanitizer in the community Both Done