Fire Department – After Hours Emergency Contact Form

Business Name*
Business
Business Address*
Street Address Postal Code
Business Phone*
After Hours Contact Name #1*
First Last
After Hours Contact Phone #1*
Would you like to add an extra emergency contact?*
- Yes
- No
After Hours Contact Name #2
First Last
After Hours Contact Phone #2
Would you like to add an extra emergency contact?*
- Yes
- No
After Hours Contact Name #3
First Last
After Hours Contact Phone #3
Would you like to add an extra emergency contact?*
- Yes
- No
After Hours Contact Name #4
First Last
After Hours Contact Phone #4
Additional Comments
Consent*
I agree
I agree to provide contact and business information to the City of Corner Brook Fire Department in this form. This will only be used in the event of an emergency.
Consent*
I agree to the privacy policy stated below.
The City of Corner Brook uses this web form to collect your information in order to better administer programs and services that citizens use and rely on. The City of Corner Brook committed to protecting the privacy of individuals who chose to utilize these services.
This information is collected in compliance with the Access to Information and Protection of Privacy Act, 2015 (ATIPPA, 2015) and will only be used by authorized staff to fulfill the purpose for which it was originally collected, or for a use consistent with that purpose unless you expressly consent otherwise. This information is not disclosed to other public bodies or individuals except as authorized by ATIPPA, 2015.