Problem Location

Park*

Elm Avenue Henry Hudson Maple Ridge Moh-He-Con-Nuck Nature Preserve North Bethlehem Selkirk

South Bethlehem Firefighters Memorial Dog Normans Kill Ravines Rupert Road Fishing Access Colonial Acres

Date*

and time

problem observed

Maintenance needed for*

Bench Sign Garbage receptacle Grass Landscaping Pavilion Bleachers Restroom Baseball/softball field Soccer field Playground Volleyball court

Fence Trees Parking area Roadway Picnic tables Flag Street hockey area (Elm Ave Park) Ice skating rink (Elm Ave Park) Fitness trail (Elm Ave Park) Fishing platform (Henry Hudson Park) Boat launch (Henry Hudson Park) Other

Brief Description (include
exact location within park)*

Photograph:

Your Information

Name:

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Address Line 2:

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