Seminole Manor Neighborhood Registry

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The information you provide will be used for Neighborhood Watch and to share news about public works projects, social gatherings, and activities that may affect you.

Your information will be held in confidence and disclosed to a select group of people. E-mail will be the primary source of information distribution, but your e-mail address will be suppressed on such communication. If no e-mail address is provided, we will use your phone number and address as the means of reaching you.

This form is two pages long and completing it should take 3 - 5 mins. Thank you for your time.

HOUSEHOLD INFORMATION

NAME: *

Provide your first and last name. If you would like your registry entry to include another household member, please provide their name as well.

HOME ADDRESS:

Enter your street address

EMAIL ADDRESS:

PRIMARY PHONE #:

SECONDARY PHONE #:

EMERGENCY CONTACT NAME:

This item is specifically for Neighborhood Watch. If there is a need for law enforcement to contact you concerning your property and you are not reachable by the other phone numbers, who would you like to have called?

YOUR RELATION TO ABOVE EMERGENCY CONTACT:

EMERGENCY CONTACT PHONE #:

ADDITIONAL INFO:

Is there any additional information about your household that you would like us to know (e.g., pets, children, or elderly household members)?

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