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Welcome to the City of Fremont, OH, Action Line

Today is Saturday, November 21, 2009.
Are You Okay?

Use this form to sign up for the "Are You Okay?" program.

* Information is required.

Contact Information

* First Name:
* Last Name:
Email:
Daytime Phone: ()  –
* Address:
City:
State:
ZIP:

* Name, address & phone number(s) of primary emergency contact.
 
In case of an emergency, do you want this person called before the police are sent?
Yes
No
3
 
* I want to be called everyday.
Yes
No
3
 
I want to be called only on the following days:
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
8
 
Optional Information. Doctor's Name
 
Other Person with key.
 
Check here to have email confirmation of this request sent.

* Information is required.

Notes:

If you are going to be away when the Are You Okay computer calls, please notify the Fremont Police department at 419-332-6464 that you will not be answering your call that day. If your going to be gone for an extended period of time, please call the above number. Your account will be deactivated until you call us back and say you are ready for your calls again..

Internal Use Only, Leave Blank:
Please leave this field blank and remove any values that have been populated for it.

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