You must have JavaScript enabled to use this form. Please use this form to report inappropriate behaviour (violence, harassment, vandalism, etc.) at Middlesex Centre recreational facilities, parks and programs. Date and Time of Incident Date and Time of Incident: Date Date and Time of Incident: Time Location of Incident Please provide the name of the municipal facility, park or program at which this incident occurred. Description of Incident Contact Information We may contact you for more details. Please ensure your contact information is correct. First and Last Name Email Phone Town Personal information collected on this form is collected under the Municipal Act for the purpose of assessing and managing inappropriate behaviour at Middlesex Centre properties. Questions about this collection may be directed to the Office of the Clerk at 519-666-0190 or clerk@middlesexcentre.ca. Leave this field blank
