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
Name: ______________________________ Title: ____________
Address: __________________________ City_______________,
Phone: (_____) ______- ___________
Fax: (_____) ______- ___________
Address or location of Barrel (if different from above):
City ___________________, State ________________
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 visit your 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
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 Rain Gardens
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?
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 are in the process of being scheduled. If you are interested in hosting one or
attending please contact Adrienne Kina, Akina@bnrivkeeper.org, 852-7483 ex. 19
Diverters, that make seasonal changes easier, are also available
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 www.bnriverkeeper.org or return this application form to:
Buffalo Niagara RIVERKEEPER
Rain Barrel Donation Program
1250 Niagara St
Buffalo, NY 14213.
For questions or more information, please contact Kerri Bentkowski at (716) 852-RIVER or