Unlisted Number Authorization Form

Submission of this form authorizes the Lake County Emergency Management Agency to include the noted unlisted telephone number in its Reverse 911 outbound calling system database for the sole purpose of receiving emergency and public service information.  Authorization is being granted freely with the understanding the number will be used only in conjunction with official business and not be released to anyone else without permission.

Please fill out the following form and submit so that we may add you to our Reverse 911 System

Tell us how to get in touch with you, please specify whether it's an unlisted land line, or a cell phone that is your only phone line.  If you have any questions or concerns, please enter them in the space provided below: