Enhanced 9-1-1 Emergency Registration Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Enhanced 9-1-1 emergency service is provided to all land telephone subscribers in Athens County, Ohio. It is highly recommended that all cellular phone subscribers register their cell phone number with the Enhanced 9-1-1 service so their information is readily available to the Emergency Communications 9-1-1 Call Center.

When you call 9-1-1 in an emergency, this new system automatically displays and relays your telephone number, address and any special conditions or instructions you provide to police, fire, or ambulance services dispatched to your location.

Special conditions or instructions can be changed or provided initially by completing the information in the form below and submitting it. All information you provide will be held in confidence.

First Name *

Last Name *

Street Address *

City/Township *

Zip Code *

Phone Number *

Is this a Cellphone? *

Yes

Email Address *

Nearest CROSS STREET or ROAD to your residence:

Briefly describe any HEALTH or DISABILITY conditions you may have which Emergency Responders should be aware of:

Please Mark for ant special conditions that may exist at your location:

Disabled/Bedridden

Hearing/Speech Disability

Oxygen/Propane used or stored

Hazardous/Flammable Material on Premises

Other:

Key Location/Emergency Contact Information *

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Athens County 911. Report Abuse

Forms