Welcome to City of High Point Form Center

Residential Emergency Contact Information

2. Residents First Name*
3. Residents Last Name*
5. Physical Address*
7. City
8. State
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9. Zip Code
11. Primary Residents Phone Number*
13. Email Address*
15. 1st Emergency Contact*
17. Home Number
18. Mobile Number*
19. Work Number
21. 2nd Emergency Contact
23. Home Number
24. Mobile Number
25. Work Number
27. Are there any guns in the residence?

    1. Yes
    2. No
    3. Prefer not to answer
28. Are there any dogs in the residence?

    1. Yes
    2. No
    3. Prefer not to answer
30. Hidden Key or Key Pad Entry Code (optional)
32. Other Comments or Safety Issues for Emergency Responders
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field