Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Thanking our Heroes

Sign in to Save Progress
  2. We are compiling videos of gratitude and support towards our First Responders and Medical Professionals during this pandemic. Please join us by submitting a short clip <20 seconds showing your gratitude and support!
  5. Please provide a contact email in case there are any issues with your submission
  7. Please upload your clip here <20 seconds please.
  9. Video Release Consent *
    By checking this box I hereby authorize the City of Madison Heights (“City”), and those acting pursuant to its authority a nonexclusive grant to: 1. Use my name in connection with these recordings. 2. Use, reproduce, publish, republish, exhibit, edit, modify, or distribute, in whole or in part, these recordings in all media without compensation for any purpose that the City, and those acting pursuant to its authority, deem appropriate, including promotional or advertising efforts. These recordings may appear in a variety of formats and media now available to the City and that may be available in the future (e.g. print publications, video tapes, CD-ROM, Internet, mobile, digital). I hereby release the City and those acting pursuant to its authority from liability, claims, and demands for any violation of any personal or proprietary right I may have in connection with such use, including any and all claims for libel, defamation, or invasion of privacy. I understand that all such recordings, in whatever medium, shall remain the property of the City. I have read and fully understand the terms of this release.
    10. Leave This Blank:

  12. This field is not part of the form submission.