Skip to Main Content
Loading
Loading
Phone: 540-483-3091
Department Directory
/QuickLinks.aspx
About Us
Operations
Animal Control
Training
Public Information
Search
Home
Form Center
Form Center
Search Forms:
Search Forms
Select a Category
All Categories
Board of Supervisors
Boards & Commissions
Commissioner of Revenue
Economic Development
Family Resources
General Properties
General Registrar
Public Safety
Sheriff's Office
Special Events
The Franklin Center
By
signing in or creating an account
, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.
DO NOT CALL Release Form (CodeRed or SmartNotice)
Sign in to Save Progress
This form has been modified since it was saved. Please review all fields before submitting.
Franklin County Department of Public Safety
1488 Franklin Street • Rocky Mount, VA 24151 • 540-483-3091
Do Not Call Release Form (Please Read statement in it's entirety)
I am aware that the Franklin County Department of Public Safety (Client) has subscribed to an alert system known as CodeRed or SmartNotice for the purpose of communicating time sensitive notifications, including without limitation emergency alerts, employee-related alerts, or other important alerts.
By completing this form, I choose to be placed on the DO NOT CALL list for service alerts issued by the Client. I understand that I may miss time-sensitive notifications, including those regarding emergencies. By signing this release, I waive all claims against the Client and ECN, their officers, agents and employees in the event that members of my household, my property, or I are adversely affected due to my request to stop receiving alerts.
Name
*
Phone number (s)
*
BY TYPING or SIGNING YOUR NAME, YOU ARE CERTIFYING THAT YOU HAVE READ AND AGREE WITH THE FOLLOWING STATEMENT IN ITS ENTIRETY.
I agree that my typed name on this document is the legally binding equivalent to my handwritten signature, and that the information provided is true and accurate.
Signature
*
Today's Date
*
Today's Date
Leave This Blank:
Receive an email copy of this form.
Email address
This field is not part of the form submission.
Submit
* indicates a required field
About Us
Contact Us
Mission Statement
Organizational Chart (PDF)
Operations
Chaplaincy Program
EMS Stations
Fire Stations
Fire & Rescue Facilities Map (PDF)
Fire Marshal
Insurance Services Office (ISO) Ratings
Operational Medical Director
Ride Along Program
Special Teams
Standard Operating Guidelines (SOGs)
Animal Control
About Us
Animal Control Policy
Contact Animal Control
Animal Shelter
Dog Licensing
Lost & Found Animals
Make a Donation
Training
Class Registration
Fire Training Board
Fire Training Facility
National Incident Management System (NIMS)
New Radio System
Student Ride Along Schedule
Training Center
Public Information
Annual Reports
Brochures
CodeRED
FEMA
Fire Chief & EMS Captain Meetings
First Responders Memorial
About the Park
Honor a First Responder
Forms
Online Forms (Fill out & Submit)
Frequently Asked Questions
National Weather Service
Newsletters
Patches
VDH Emergency Medical Services
Virginia Department of Emergency Management
Virginia Department of Fire Programs
Volunteer Portal
Company Nurse
Frequently Asked Questions (PDF)
Injury Hotline (PDF)
Injury Reporting Guide (PDF)
Temporary Prescription Card (PDF)
Forms for Download
Designation of Beneficiaries Form (PDF)
SMS Roster Form (PDF)
Stipend Payment Forms (PDF)
Vehicle Maintenance Form (DOC)
Forms for Online Submittal
Change of Certification
Training Equipment Request
Volunteer Today
Volunteer
Class Registration
CodeRed
Dashboard
Employment
FAQ’s
Forms
Government Websites by
CivicPlus®
Arrow Left
Arrow Right
[]
Slideshow Left Arrow
Slideshow Right Arrow