Blind Child Sign Request

Please review the blind child sign standard operating procedures before applying to see if you qualify.

* Parent's Name

* Email Address

* Phone Number

Child's Name

* Date of Birth

* Age

* Full Address, City, State, Zip

* Is there a speed limit sign posted at 25 mph on your street?

Select One Yes
No

* Is child legally hearing and visually impaired?

Select One Yes
No

* Doctor

Select One I understand that upon submitting this form I'll be required to submit a proof of residency and an examination record. We will contact you for further information.

Report a Problem

Potholes, Street lights, etc.

Public Works Operations
604 West 6960 South
Midvale, UT 84047
Phone: (385) 468-6101
Email

Blind Child Sign Request

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