CodeRED Application

East Point Fire
3121 Norman Berry Drive
East Point, GA 30344

Office: (404) 559-6401 | | Fax: (404) 765-1172
Email: Fire@EastPointCity.org
Website: www.eastpointcity.org

CodeRED Application Form
*Please return this form via online submission, fax or mail.
Online submissions, please fill form and submit.
Fax or mail submission, please print and return to one of the addresses listed at the end of this form.

The City of East Point solicits your enrollment into our Code Red Emergency Notification Network. Your enrollment will afford you the option of receiving emergency or non-emergency notifications. Emergency notifications will include: Evacuation Notices, Missing Child Alerts, Gas Leaks, Power Outages, Flood Notifications and much more. Please complete the short form below:

Date*

MonthDayYear

Name:*

Residential or Commercial?*

ResidentialCommercial

Address:*

Physical Address Only (No PO Boxes)

Which type of notification would you like to receive?:*

EmergencyNon-Emergency

Do you live in a mobile home or manufactured home?:*

MobileManufactured

Do you require special assistance in an Emergency or Non Emergency? (i.e. Asthma, Ventilator requiring electricity, Wheelchair, etc.):*

YesNo

Type Assistance Needed?

Primary Telephone:*

Phone Service Provider?:*

OTDD / TTY Device?:*

YesNo

Mobile Phone?:*

YesNo

Receive Text Messages?:*

YesNo

Secondary Telephone:*

Phone Service Provider?:*

OTDD / TTY Device?:*

YesNo

OTDD / TTY Device?:*

YesNo

Mobile Phone?:*

YesNo

Email:*

How do you prefer receiving information?:*

EmailTextVoice

Which Group best describe your age?:*

Are you a member of the R.U.O.K. program?:*

YesNo

Would you like to become a member of the R.U.O.K. program?*

YesNo

Are your experiencing problems with your Electrical, Water or Yes No Sewer services?:*

YesNo

If yes, what service?:

Do you experience periodic flooding?:*

YesNo

Does a snow event cause a problem accessing your street?:*

YesNo

Do you have a Smoke Alarm in your home?:*

YesNo

Do you have a Carbon Monoxide Detector in your home?:*

YesNo

Would you like to have a Smoke Alarm installed?:*

YesNo

Would you like to have a Carbon Monoxide Detector installed?:*

YesNo

Would you like to have a Home Inspection?:*

YesNo

Are you interested in volunteering for the Department of Parks and Recreations? :*

YesNo

Would you be interested in program related information offered by the Department of Parks and Recreations?:*

YesNo

Form Drop-off Locations:

Fire Station #2:
3171 Norman Berry Drive, East Point GA 30344

Fire Station #3:
3800 North Commerce Drive, East Point GA 30344

Fire Station #4:
2222 Ben Hill Road, East Point GA 30344

City Hall:
2757 East Point Street, East Point GA 30344

Mission Statement
To provide exceptional city services in the most professional, courteous and effective manner to enhance the quality of life in the City of East Point.