As part of the Village's COVID-19 Response Plan, If self-quarantined or other residents who feel at risk to COVID-19 so choose, they may give the Village Hall their contact information so staff can call to ensure that they are healthy and safe. Staff shall document all such contact made, and in the event of failure to establish contact with an individual, notify the appropriate person that they designate to contact in such an event.

Your Name:

Your Local Address:

Your Phone Number:

Your email:

Emergency Contact Name:

Emergency Contact Phone Number:

Best Time of Day to Contact: