Patron and Visitor ADA Complaint Form

Date of Visit dd/mm/yy
I am Complainant
Authorized Representative
Full Name
Email
Phone
Address
Address line 2
City
State/Territory
Zip/postal code
Country
Alleged Violations

Describe the circumstances and the specific location, i.e. park name/location ,that prompted your specific ADA complaint. Please be specific and provide details.
Requested Action

Please describe the accommodation or request that would help to provide you with greater access to our facilities, programs or services.