2. Name*
4. Address*
6. Home Phone Number
7. Cell/Emergency Phone Number*
9. Emergency Contact*

   Please list someone who is NOT a household member. Include their name, number, and their relation to you.

11. Alarm Company Phone Number*
13. Special Needs Person
    Would you like further information regarding the State of Texas Emergency Assistance Registry (STEAR) program? This is a free registry that provides additional information for individuals with disabilities or special needs in their community that may need assistance during an emergency situation. For more information or to get a registration form, please contact the police department.
15. Would you like to be added to the No-Knock List?*

    This list of addresses only is given to solicitors to indicate which residents do not wish to be contacted.

    1. Yes
    2. No
17. Pets
19. Email Address
21. Would you like to receive notices from the city regarding police alerts, important upcoming events, and general alerts including weather and public works? Please visit the Notify Me section of the website. If you have any questions please contact the webmaster, Donna Terrell.
Leave This Blank:


23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit

* indicates a required field