Graffiti Clean Up Kit
FOIP Statement
Your personal information is being collected under the Authority of Section 33 (c) of the Freedom of Information and Protection of Privacy Act, and will be used to aid in maintaining accurate records, to provide contact information for the program and to administer the Graffiti Management Program. It will be treated in accordance with the privacy protection provisions of Part 2 of the Freedom of Information and Protection of Privacy Act. If you have any questions about the collection, contact the Volunteer Coordinator, 2nd Floor, Beaufort Building, 10835 – 120 Street, Edmonton AB, T5H 3P9 or (780) 496-8047.
* Required
Name
*
Your answer
Phone Number
*
Your answer
Email Address
*
Your answer
Address
*
Your answer
Business Name
If applicable
Your answer
Is this building a designated historic building?
*
Yes
No
Did you receive a notice form a City of Edmonton Bylaw Officer?
*
Yes
No
If Yes, please include your reference number
Your answer
Type of surface
*
Check all that apply
Raw Brick
Painted
Stucco
Concrete
Siding
Glass
Wood
Metal
Stone
Other:
Required
Did you take photos of the graffiti?
*
All applications must include photos to be considered.
Yes
No
Did you report the graffiti vandalism to EPS?
*
Yes
NO
Edmonton Police Service (EPS) file number
*
EPS file is required for application to be considered. Report online to EPS at
http://www.edmontonpolice.ca/ContactEPS/OnlineCrimeReporting.aspx
Your answer
Do you wish to receive emails from Capital City Clean Up which may contain commercial content (this could include information such as giveaways from our program partners)?
*
We will not share your email address outside of our organization.
Yes
No
Please indicate which items you require for your graffiti kit
*
Capital City Clean Up reserves the right to substitute, add or remove items as they deem necessary.
Graffiti Chemical Removal Wipes
Gloves
Painting Tray
Paint Brush
Wire Cage Roller
Discount Coupon for paint from RONA
Required
By clicking the yes button and submitting the form, this constitutes signature.
*
Yes
No
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