Required fields are marked with asterisks (*)

Alarm Registration Application

Personal information contained on this form is collected under the authority of the Municipal Act, 2001, S.O. 2001, c.25 and will be used for the purpose of administering the Municipality of Lakeshore's alarm registration program.

It is the alarm user's responsibility to ensure that a valid alarm registration exists and to provide updates as to changes in contact information.

Are there any pets on the premises?

Yes

Premise Information

Company Name (or householder name if a residential property)

Address of Protected Premises

Mailing Address if Different Than Protected Premises

Phone Number

Alarm Information

Type of Protected Premises

Residential

Commercial

Pharmacy

School

Financial Institution

Type of Alarm

Monitored

Non Monitored

Video

Other (please specify)

Key Holder Information

Name

Home Phone Number

Cell Phone Number

Other Phone Number

Name

Home Phone Number

Cell Phone Number

Other Phone Number

Name

Home Phone Number

Cell Phone Number

Other Phone Number

Confirmation

By checking this box and submitting this form, I confirm the following:

I consent to the collection of my personal information included on this form, for the purpose of administering the Municipality of Lakeshore's alarm registration program.

Note: Questions regarding the collection, use and disclosure of this personal information may be directed to:

Division Leader - Civic Affairs
Municipality of Lakeshore, 419 Notre Dame, Belle River, ON N0R 1A0
clerk@lakeshore.ca

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Alarm Registration Application

Premise Information

Alarm Information

Key Holder Information

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