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Knox Home Box Key Program

2. Thank You for Your Interest in the Knox Home Box Key Program
   The program is designed to provide a non-destructive method for entering the home of an incapacitated individual or individuals by providing a safe, secure lockbox on the home's exterior, accessible only by authorized Melissa Fire Department personnel. The program is free, but residents must qualify based on criteria set by the Melissa Fire Department. Residents who fill out this form will be contacted to determine eligibility.
4. Name
6. Address
8. City
9. State
10. Zip Code
12. Phone Number
13. Email Address
15. Comments (Please Include Risk/Issue and Any Notes or Special Instructions)
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17. 1. Receive an email copy of this form.
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