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2. First Name*
3. Last Name
5. Phone Number
6. Email
8. Thank you for reaching out to us today. Please complete the form below so we know how best to be of assistance.
10. Reason for contacting City staff.*
    -- Select One --CommentComplimentConcernQuestionOther
11. Location Type*
    -- Select One --Open SpaceParkStreet TreeTrailCity Facility
13. Park
    -- Select One --Carson ParkClara May Berry ParkCoast Guard ParkCooper Gulch ParkDa' Yas ParkDel Norte Street Park & Dog ParkEureka Dog ParkEureka Skate ParkHalvorsen ParkHammond ParkHartman Ball FieldHighland ParkJacob Haney Ball FieldKamisu ParkKennedy Ball FieldLundbar Hills ParkMyrtle Grove Memorial CemeteryOld Town GazeboRoss ParkSacco AmphitheaterSequoia ParkSequoia Park Flower Garden
14. Facility
    -- Select One --Adorni Community CenterClarke PlazaCoast Guard PlazaCooper Gulch Recreation BuildingEureka Municipal AuditoriumEureka Municipal Golf CourseEureka Public MarinaJohn Ryan Youth CenterMadaket PlazaOld Town GazeboRedwood Sky WalkSequoia Park ZooWharfinger BuildingOther
15. Trail
    -- Select One --Eureka Waterfront TrailCooper Gulch Park TrailsSequoia Park Trails
16. Other Location

    Enter address, cross street, nearest landmark/business, etc.

18. Please describe why you are contacting staff today.*
20. Upload a file or photo.

    Submit a file/photo to staff to accompany your form.

21. Upload a file or photo.

    Submit a file/photo to staff to accompany your form.

22. Upload a file or photo.

    Submit a file/photo to staff to accompany your form.

24. Would you like staff to follow up with you?*
    -- Select One --YesNo
25. How would you like staff to contact you?
    -- Select One --EmailPhone
Leave This Blank:


27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit

* indicates a required field