Tenant Emergency Information Questionnaire

Please fill out this form to help us reach the right people or respond appropriately in an emergency involving your unit.

Primary Tenant

Tenant Name:*

First Last

Tenant Contact Number*

Emergency Contact Info

Emergency Contact Name:*

First Last

Emergency Contact Phone Number:*

Relationship to You:*

Parent
Spouse
Sibling
Friend
Other

Other Adults

Other Adults Living in the Unit

Full Name	Phone Number	Employer	Employer Phone Number

(List each adult separately with their contact and work info)

Other Children

Children Living in the Unit

Name	Age

(List each child by full name and age)

Other Info

Your Employer*

Work Phone Number (for emergency purposes)*

Do you consent to us entering your unit in the event of a suspected personal emergency (wellness check, etc.).? (Note we still can enter due to threat to property due to flood, no heat, fire, etc)*

Yes
No

Any allergies, medications, or medical conditions you’d like to share for emergency responders?

Preferred Hospital/Doctor

Animals in Unit (Name, type, age, vet info, health conditions, emergency caretaker):

Notes