Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Block Captain Application Form

  1. Thank you for your interest in becoming a Block Captain!

    Block captains help oversee and maintain the traffic control set-ups on Healthy Streets (barricades, barrels, and signs). They also stay in touch with the project team to provide their own observations and suggestions for improvements to existing streets. Complete the following form for submission.

  2. What Healthy Street are you interested in being a Block Captain for?

  3. Leave This Blank:

  4. This field is not part of the form submission.