Reverse 911 Enrollment / Removal Request Form
The Beaver County Sheriff’s Office in conjunction with Iron County Emergency Services would like to invite you to register your Cellular, Voice Over Internet (VoIP) or Unlisted telephone number so that we may notify you of situations that may have an impact on you and your loved ones. Reverse 911 is a telephone notification system we use to notify the public of significant incidents effecting local neighborhoods and specific geographic areas within the cooperative counties.

Once registered, your telephone numbers will not be used for any other purpose. Your numbers will remain absolutely confidential. Messages delivered to your telephone number will always be brief, informative, and provide you with direction to ensure the safety of your family, home or business.

Please take a moment and fill out this registration form to provide us with the most up to date information regarding your home or business telephone numbers. Please include any number that is not a traditionally listed number. Also, if a number is no longer in use, please request to have it deleted from the system. This information will allow us to remove unnecessary duplicate entries from the Reverse 911 system to ensure its efficiency and effectiveness. With your assistance, we can quickly notify you of pending significant events.

This form must be filled out for each phone number
that you would like to have registered!



- PLEASE ADD MY INFORMATION
- PLEASE DELETE MY INFORMATION

First Name:

Middle Initial:
Last Name:

Street Address:

OPTIONAL   Address:
City:
State:
County:
Zip Code:
Email:

REMINDER: It is not necessary to submit any currently published (listed) land-line phone numbers.

Phone Number:
This is the number that you want registered.
( ) -
Phone Location: Residential  
  Business  
Phone Type: Cell Phone VoIP  
  TDD/TTY Unlisted Land-Line  
By signing below and submitting this Reverse 911 Registry Request form to the Beaver County Sheriff's Office, I am giving the Beaver County Sheriff's Office and Iron County Emergency Services permission to use my telephone numbers to provide me with significant information pertinent to myself, my family, and/or my residence or business located in Beaver County, Iron County, New Harmony, or Enterprise.
Type your full name below exactly as you entered it above: