City of North Adams

Office of Public Safety

40 American Legion Drive
North Adams, MA 01247
413-662-3102

CodeRED REGISTRATION FORM

I am aware that the City of North Adams has subscribed to an alert system known as
CodeRED. The City of North Adams may use the alert system to communicate with the
public in cases where prompt notice to protect life, health or property is
advantageous.
Please provide the information below and return it to:

CITY OF NORTH ADAMS

OFFICE OF PUBLIC SAFETY
40 AMERICAN LEGION DRIVE
NORTH ADAMS MA 01247
(413) 662-3102
(413) 662-3008 fax
Name:

_____________________________

Address: __________________________________
__________________________________

Telephone number(s) to be placed in the Emergency Notification System:

Cell phone provider (if applicable):_________________

Email address(s) to be placed on the Emergency Notification System:

_______________________________________________________________________

Names of others residing at the above address:

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

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Signature

Date