<form-template> <fields> <field type="date" required="true" label="Date you received the ticket:" class="form-control calendar" name="date-1650379796578"></field> <field type="text" subtype="text" required="true" label="Time you received the ticket (hh:mm am/pm):" class="form-control text-input" name="text-1650379749221"></field> <field type="text" subtype="text" required="true" label="Offence Ticket Number:" description="Located at the top left of the ticket underneath the barcode" class="form-control text-input" name="text-1650379749438"></field> <field type="file" label="Upload Supporting Evidence (documents or photos) " class="form-control file-input" name="file-1650379767704"></field> <field type="text" subtype="text" required="true" label="First Name:" class="form-control text-input" name="text-1650379750536"></field> <field type="text" subtype="text" required="true" label="Last Name:" class="form-control text-input" name="text-1650379750872"></field> <field type="text" subtype="text" label="Telephone Number:" class="form-control text-input" name="text-1650379751552"></field> <field type="text" subtype="text" required="true" label="Email:" class="form-control text-input" name="text-1650379751808"></field> <field type="text" subtype="text" label="Street Number &amp;amp;amp;amp; Name:" class="form-control text-input" name="text-1650379752192"></field> <field type="text" subtype="text" label="PO Box Number:" class="form-control text-input" name="text-1650379752416"></field> <field type="text" subtype="text" label="City:" class="form-control text-input" name="text-1650379752870"></field> <field type="text" subtype="text" label="Province/State:" class="form-control text-input" name="text-1650379753205"></field> <field type="text" subtype="text" label="Postal Code/ZIP:" class="form-control text-input" name="text-1650379754000"></field> <field type="text" subtype="text" label="Country:" class="form-control text-input" name="text-1650379754574"></field> <field type="select" required="true" label="Complaint or Request to Withdrawal Ticket:" class="form-control select" name="select-1650379757308"> <option value="Select One" selected="true">Select One</option> <option value="Bylaw Complaint">Bylaw Complaint</option> <option value="Request to withdraw ticket">Request to withdraw ticket</option> </field> <field type="textarea" label="Complaint/Concern Details:" class="form-control text-area" name="textarea-1650379763636"></field> <field type="paragraph" subtype="p" label="Notice of Collection of Personal Information - The Municipality is collecting your personal information including name; contact information; and incident details; under the authority of Section 4(c) of Alberta’s Protection of Privacy Act. This information will be used by the Municipality in order to collect complaints and issues and to allow for a response to complaints and issues. The Municipality may use and disclose your personal information where permitted or required to by law, including where permitted by the Access to Information Act or Protection of Privacy Act. If you have any questions about the collection of your personal information, you may contact the Municipality’s Privacy Officer at privacy@jasper-alberta.ca ." class="paragraph"></field> </fields> </form-template> Submit Submitting...
