Fox Lake, IL · Lake County
Premise Alert Program Notification Form
This form lets individuals or people familiar with them share special-needs information with FoxComm for use by responding public safety personnel.
What this form is
The Premise Alert Program Notification Form lets an individual or someone familiar with them provide information to FoxComm for police, fire, and EMS responders. It asks for contact, residence, employment or educational facility, and special-needs details, plus the signer’s relationship and signature. The notification expires after two years; the information may be updated, renewed, or removed by filing the form.
Who needs it
An individual with special needs, or a family member, friend, caregiver, or medical professional familiar with them, may submit this form.
How to submit it
Return the completed form to FoxComm E9-1-1 Communication Center, 301 S. Route 59, Fox Lake, IL 60020, as directed on the form.
About notarization
This form is signed and dated without a notary; it does not identify any notarized attachment or related step.
How to submit this form
- 1
Download The Form
Download the Premise Alert Program Notification Form.
- 2
Complete The Form
Print legibly and provide the requested individual, contact, and special-needs information.
- 3
Sign And Date
Read the terms, then print your name, relationship to the individual, and signature and date.
- 4
Submit To FoxComm
Return the completed form to FoxComm E9-1-1 Communication Center at the address listed on the form.
Frequently asked questions
- What does the Premise Alert Program Notification Form do?
- It lets individuals or someone familiar with them provide information for police, fire, and EMS personnel responding to situations involving a person with special needs.
- Who can complete the form?
- The signer may be the individual, a family member, friend, caregiver, or medical personnel familiar with the individual, as stated on the form.
- Do I need a notary for the Premise Alert Program Notification Form?
- No. This form is signed and dated without a notary, and it does not identify any notarized attachment or related step.
- How do I submit the Premise Alert Program Notification Form?
- Return the completed form to FoxComm E9-1-1 Communication Center, 301 S. Route 59, Fox Lake, IL 60020.
Need something notarized?
This Premise Alert Program Notification Form doesn’t need a notary — but Illinois residents can notarize other documents online with a commissioned online notary.