Americans with Disabilities Complaint Form

It is the policy of the East Bay Regional Park District (“Park District”) that no member of the public shall be in any way discriminated against because of mental or physical disability or medical condition. Section 5.0 of the Park District’s Self-Evaluation and Transition Plan sets forth the Park District’s ADA policy and complaint procedure. (Available at www.ebparks.org)

Please use this form if you believe the Park District has not provided satisfactory accommodation for a disability.

The completed form will be submitted to:

East Bay Regional Park District
Attention: ADA Coordinator
2950 Peralta Oaks Court Oakland, California 94605
E-mail: adacoordinator@ebparks.org
Phone: 510-544-2158

ADA Complaint Form

Name

Phone Number

Address

City/Town

State/Province

ZIP/Postal Code

Description

Please describe the condition of concern and any requested remedy. Include date, time, location, and specific information. If necessary, attach additional pages with your name on each page.

Signature

Sign above

Date

Americans with Disabilities Complaint Form

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