Emergency Contact Form

As a service to you and as a requirement of our Occupational License please fill out this questionnaire for the Grain Valley Police Department’s Emergency Notification System.

This will enable the Police Department to notify you if or when there is an emergency, alarms are activated, water or power problems occur, or when open doors and windows are found. We appreciate your cooperation.

Emergency Business Contact Form

Please Select One:

Secondary Emergency Contact Information (If you are unable to be contacted)

Business Name

Address

City

State

Zip Code

Business Phone

Alarm Company Name

Alarm Company Phone

Are there any hazardous chemicals on / in this property? (If “yes” please list chemicals below):

Are there any explosives, including ammunition, on this property?

Are there any security cameras located on your property?

What portion of the business do the cameras cover?

If your business has a security code for a door or gate for officers to use, please contact us at 816-847-6250

Owner Information

Business Owner's First Name

Business Owner's Last Name

Address

City

State

Zip Code

Home Phone

Cell Phone

Secondary Emergency Contact Information (If you are unable to be contacted)

Name 1:

Phone 1:

Name 2:

Phone 2:

Name 3:

Phone 3:

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719 R.D. Mize Road · Grain Valley, MO 64029

Emergency Contact Form

Emergency Business Contact Form

Secondary Emergency Contact Information (If you are unable to be contacted)

**** If your business has a security code for a door or gate for officers to use, please contact us at 816-847-6250 ****

Owner Information

Secondary Emergency Contact Information (If you are unable to be contacted)

Resources & Services

Map · Grain Valley Police

If your business has a security code for a door or gate for officers to use, please contact us at 816-847-6250