Virtual Services

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Virtual Services

Please complete and submit- Thank You! Completela y envíela - ¡Gracias!

Email *

Untitled Title

Full Name *

Telephone Number *

Today's Date *

YYYY

What is your home address? *

Age Group *

Gender *

Male

Female

Non-binary

Prefer not to say

Ethnicity *

Asian

Black / African American

White

Hispanic / Latino

Prefer not to say

How did you hear about our program? *

Service Requested *

Do you have access to a high speed internet at home? *

Yes

Not Sure

Do you have children 0-18? if so, what are their genders and ages? *

Do you speak any other languages? *

Photo Policy *

Yes, I hereby and give consent to the city of Salinas, its successors and assigns, to copyright, publish and display all photographs and videos taken by them in which I agree to appear. It is further agreed that the City may use, or caused to use my photographs or image for any or all exhibitions, public displays, flyers, brochures, commercial art, advertising purpose, and Salinas City website, without limitations or reservations or any compensations.

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