Unite to Light: Request Form

* Required field

This is a service request application for the Youth Advisory Commission and associated volunteers to install exterior holiday lights and/or decor for community members who are in need of help decorating for the holidays. This application is not a guarantee for assistance to be provided. Please fill out the form completely by December 5th and a City of Page staff member will contact you if you are selected to receive assistance. Assistance will be provided on December 6, 2024 starting at 11am.

Full Name: *

Phone number: *

Email Address:

Address of residence: *

Do you own exterior holiday lights?

Yes

Do you own outdoor holiday decorations?

Yes

Is your residence single-level?

Yes

Additional comment/request:

Please confirm your signature by typing your full name in the box below.

I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature.