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2. First Name*
3. Last Name*
5. Would you like us to follow up with you?*

   1. Yes
   2. No
7. Email*
9. Name of park or or location of the concern you are reporting*
11. Please share the date in which you observed the maintenance concern*
13. What type of concern are you reporting? *

    Check all that apply

    1. Damaged playground equipment including basketball hoops, benches, drinking fountains, tables, fences.
    2. Mowing / High Grass
    3. Restrooms needing attention
    4. Litter
    5. Graffiti
    6. Lighting or lights not turning on
    7. Fallen branches or dead trees in parks
    8. Safety Concerns
    9. Other
15. Please describe in detail the concern you are reporting.*
17. Upload Photo
18. Upload Photo
19. Upload Photo
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21. 1. Receive an email copy of this form.
22. Email address

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23. Submit Submit and Print

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