KNW Membership Form

Please add any additional household member’s that you would like to receive information. Include their names with their phone numbers and emails in the Additional Phone Numbers section.

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Names of Adults in the Home

Number of Children in Home

Home Phone Number

Work Phone Number

Mobile Phone Number

Text Message Alert: General Text Alerts (Suspicious vehicles, Burglary Reports, Activities in Area) and Emergency Text Alerts (Tornado Warnings, Wildfire Evacuations, Burglaries in Progress, Road Closings due to MVA)(required)

Please send me both General and Emergency Text Alerts

Please send me Emergency Texts Only

I do not wish to receive any text messages

Home Address

County

Additional Phone Numbers & Emails

Emergency Contact (Name, Address, Phone #)

Medical or Health Problems of any Household Members (In case of emergency and you are unable to communicate with EMS or for assistance during an evacuations)

Medical Training or Skills

Other comments:

I am interested in becoming a block captain for my area.

Contact Keystone Neighborhood Watch Coordinator Shelly Long with any Questions 918-246-6644

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KNW Membership Form

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