Emergency Notification Form

Emergency Notification Castle Pines Homes Association has implemented a Reverse 911 system to notify residents in the event of an emergency. Please provide the phone number you would most like to receive the emergency notification (Primary). This may be, but does not have to be, your home telephone number.

In addition, this system may be used to provide you with information of a non-emergency nature. The home number (Secondary) will be used for non-emergency messages.

Please complete and return this form to the Castle Pines Homes Association and Emergency Services office located at 688 Happy Canyon Road, or you may leave it at any access control gate. For questions, please contact Emergency Services at 303-688-6447.

I authorize Castle Pines Homes Association and Emergency Services to notify me at the following numbers in case of emergency or to provide other information deemed necessary.

Emergency Number (Primary)(Required)

Home Number (Secondary)(Required)

Please note: the Primary and Secondary numbers may be the same if you choose to receive emergency information at your home telephone number.

I understand that I am responsible for keeping Castle Pines Emergency Services informed of changes to my contact numbers. Failure to do so may result in no emergency information being received from the Reverse 911 system.

My home is or is not equipped with a Knox box with a current key.(Required)

Yes, it is

No, it is not

Name(Required)

Village Address(Required)

Signature(Required)

Date(Required)

Castle Pines Emergency Services ♦688 Happy Canyon Road, Castle Rock, CO 80108 ♦ 303-688-6446

www.thevillagecastlepines.com

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