Fridley Block Captain Application

Fridley Block Captain Application

Submit this form to request to become a Fridley Block Captain for your neighborhood.
Please note: If you are unable to fill out this form, please email web-Info@fridleymn.gov and the City of Fridley will provide assistance.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Block(s) you would like to be responsible for:*