Room Safety and Privacy Agreement
Please review and acknowledge the safety and privacy expectations for your room.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Room Number or Location
*
Emergency Contact Name
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Who is allowed to access your room?
*
Only myself
Roommates
Authorized staff (maintenance, cleaning, etc.)
Other (please specify)
Please indicate which of the following safety features are present in your room:
*
Smoke detector
Fire extinguisher
Window locks
Security camera (public areas only)
Other (please specify)
How do you prefer to be notified of maintenance or inspections?
*
Email
Phone call
Text message
Other (please specify)
Have you read and understood the room safety and privacy guidelines provided?
*
Yes, I have read and understood the guidelines.
No, I need more information.
Please describe any safety or privacy concerns you have regarding your room.
Incident Reporting: Please describe any past incidents or concerns (if any) related to your room's safety or privacy.
Signature
*
Submit Agreement
Submit Agreement
Should be Empty: