1

What type of issue are you reporting?

 *

What type of issue are you reporting?

General maintenance/cleanliness

High grass/weeds

Staff or service complaint

Trash/graffiti

Damage to equipment or facilities

Other (please describe) If other, type text here.

2

At which Town of Leesburg park did you notice this issue?

 *

At which Town of Leesburg park did you notice this issue? (Select an Answer) AV Symington Aquatic Center Brandon Park Carrvale Park Catoctin SkatePark Edwards Landing Park Foxridge Park Freedom Park Georgetown Park Greenway Park Ida Lee Park Ida Lee Recreation Center Ida Lee Tennis Center Leesburg Dog Park Mervin Jackson Park Olde Izaak Walton Park Potomac Crossing Park Raflo Park Robinson Park Rotary Park Tuscarora Creek Park Veterans Park at Balls Bluff Other/I Don't Know

3

When did you notice this issue?

 *

When did you notice this issue?

4

Please describe the issue you are reporting:

 *

Please describe the issue you are reporting:

5

If you can, please upload a photo of the problem.

If you can, please upload a photo of the problem. Click button for uploading file Clear Maximum size allowed: 5 MB Allowed types: .gif, .jpg, .jpeg, .png, .doc, .docx, .xls, .xlsx, .rtf, .pdf, .txt

6

Do you wish to be contacted regarding the resolution of this issue?

 *

Do you wish to be contacted regarding the resolution of this issue?

Yes

No

7

If you would like to be contacted, please provide a phone number or email address below.

If you would like to be contacted, please provide a phone number or email address below.

Thank you for taking the time to complete this form and let us know about the issue you observed. If you requested a response, Town staff will reply within 2-3 business days.

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

Page 1 / 1