Guardian Calling Application

Please complete this form in it's entirety. This form will be forwarded to the 911 Center as soon as you click "SUBMIT". Someone will contact once the application is received and processed.

Contact information:

First name:

* required

Last name:

* required

Address:

* required

Phone number:

* required

1st Notification Phone Number & Name:

* required

2nd Notification Phone Number & Name:

* required

Weekday & Time for Guardian Call:

* required

COMMENTS: PLEASE INCLUDE MEDICAL, DISABILITY OR HAZARD SPECIFICS

The Guardian Notification System will be used to assist and or notify family members of possible emergency situations when the contact cannot be contacted by this agency during the specific times listed. If a number is not available for a family member to be contacted the system will phone and alert the 911 Center to send units for a welfare check. Please list any medical or hazard situations our department may need to know about the contact or location in the comment section. If you have any questions, please phone the Business Office at 423-989-5653 or 423-968-7506. The 24 hour number for the 911 Center is 423-989-5600.

PLEASE NOTIFY THE 911 CENTER IF THE CONTACT WILL BE GONE DURING THE SPECIFIED CALLING TIMES SO THE GUARDIAN CALLS MAY BE TEMPORARILY DISABLED.

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Bristol Tennessee 911 * 801 Anderson St * Bristol * TN * 37620
423-989-5653 Business Office * 423-989-5718 Fax