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Welcome to the Village of Skokie, IL, Action Line
Today is Tuesday, June 18, 2019.
WARNING! Please do not use this form to report issues of an emergency nature or for conditions requiring an immediate response. If your issue is an emergency, please use the telephone and dial 911.
Rat Control Release of Liability Form

Skokie Health Department

5127 Oakton Street, Skokie, Illinois 60077 (847-933-8484

* Information is required.

* I, The Owner

First Name

* Last Name
* Have Control of the property at (enter street address)
* City
* State
* Zip
* Does anyone on the property have a dog?

* Phone Number Where You Can Be Reached
Email Address
* Today's Date
* Please provide a description of problem.
* I give my permission to employees of the Village of Skokie and/or its contractor, a licensed pest control operator, to come onto the property to do work required to exterminate or to bait for rats. I understand that pesticides may be used in this process. I will do my part by cleaning the yard and removing any bulk items, by not feeding pets outside, and will use my durable refuse carts and keep the lids closed at all times. I also agree to release the Village from any claims or actions arising out of or related to the Health Department Rat Control Program.

Please Check Box Below



* Information is required.


If you send us a message, you will receive a Tracking Number allowing you to follow-up with your request, at your convenience.

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

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