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Adverse Water Notification Form

* Indicates required field

Name *

First

Last

911 Number *

Street *

Home Phone Number *

Cell Phone Number *

Cell Provider *

Email *

Would you like to be added to the notification list or removed from the list *

Yes I would like to be added to the notification list No, I would like to be removed from the notification list

Prefered method to be contacted, check all that apply *

Home Phone Cell Phone Text Message Email

Comment *

Submit

This form is intended to be filled out by residents who would like to be made aware when there is an anticipated unplanned event that may affect the water pressure and colour. Notifications will be sent out at any time of day or night.

All though every effort will be made to contact those on the notification list there may be times where it is not possible to do so.

If at anytime you would like to be removed from the Adverse Water Notification list complete this form and check that you would like to be removed from the list.