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Knox Box Request

  1. City of Temple Terrace Fire Department logo

  2. Temple Terrace Fire Department Residential Knox Box Request Form

  3. Program Information

    This service provides a secured lock box which attaches to the front door of your home. A spare key to your home is locked inside allowing the Temple Terrace Fire Department rapid access to your home during a fire or medical emergency. This reduces our response time in getting to you during medical emergencies where you may not be able to open/unlock the door. This also prevents unnecessary damage to the door or windows of your home. Please have a spare key ready before submitting this form. It is also recommended to have a medical information sheet listing your Name, Date of Birth, medical history, medications, allergies, and emergency contacts.

  4. Knox Box applicant / location installation information.

  5. Do you own your home?*

  6. Do you have an alarm?*

  7. Do you enter your home from the front door?*

  8. Emergency contact information.

  9. Agreement Acknowledgement *

    Submittal of this form hereby authorizes the City of Temple Terrace Fire Department to install a residential Knox Box at my residence. I understand that this Knox Box is property of the Temple Terrace Fire Department, is on loan to me, and will be returned upon my vacating the premises or if I no longer need the use of this service.

  10. Leave This Blank:

  11. This field is not part of the form submission.