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Resident Emergency Contact Form

  1. In order to better assist you in times of an emergency, the Village of Riverside is offering all residents the opportunity to provide the Fire/Police Departments with pertinent information. This program is completely voluntary. The information provided will be used for emergency purposes only.
  2. Resident Information
  3. Pet Information
  4. Dogs on the premise?
  5. Exotic Pets?
  6. Home Information
  7. Not including basement.
  8. Basement?
  9. Attic?
  10. Do you have a fire sprinkler system?
  11. Do you have an exterior lock box?
  12. Any hazardous chemicals (other than normal household supplies) stored in your home?
  13. Electronic Signature Agreement
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
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