Public Concern Form

<form-template>
	<fields>
		<field type="header" subtype="h1" label="PUBLIC CONCERN FORM" class="header"></field>
		<field type="text" subtype="text" required="true" label="Name(s):" description="Name of Complainant(s) " class="form-control text-input" name="text-1662501950340"></field>
		<field type="date" label="Date" class="form-control calendar" name="date-1662502029232"></field>
		<field type="text" subtype="text" required="true" label="Address" description="Complainant's Address" class="form-control text-input" name="text-1662502053049"></field>
		<field type="text" subtype="text" required="true" label="Phone" description="Complainant's Phone Number" class="form-control text-input" name="text-1662502152667"></field>
		<field type="text" subtype="text" required="true" label="Email" description="Complainant's Email Address" class="form-control text-input" name="text-1662502181130"></field>
		<field type="text" subtype="text" required="true" label="Location of Offence" class="form-control text-input" name="text-1662502227174"></field>
		<field type="checkbox-group" required="true" label="Reason(s) for Concern" description="Please Check Appropriate" class="checkbox-group" name="checkbox-group-1662502285801" enable-other="true" other="true">
			<option value="Dog">Dog</option>
			<option value="Unsightly Property">Unsightly Property</option>
			<option value="Garbage">Garbage</option>
			<option value="Dumping">Dumping</option>
			<option value="Graffiti">Graffiti</option>
			<option value="Parking">Parking</option>
			<option value="Snow-or-Ice">Snow or Ice</option>
			<option value="weeds-and-grass">weeds and grass</option>
			<option value="noise">noise</option>
			<option value="fence-height">fence height</option>
			<option value="burning">burning</option>
			<option value="pothole">pothole</option>
			<option value="sprinkling">sprinkling</option>
			<option value="business license">business license</option>
			<option value="zoning">zoning</option>
		</field>
		<field type="textarea" required="true" label="Details of Concern" description="Record what happened, who is involved, dates, times etc." class="form-control text-area" name="textarea-1662502664258"></field>
		<field type="file" label="Documentation" description="Upload documentation such as pictures" class="form-control file-input" name="file-1662502727874" multiple="true"></field>
	</fields>
</form-template>

Skip To Content

District of Hope

Main content of the website

Public Concern Form