Alarm and Key Code Request form

By submitting this form, I understand that I will have partial or full access to the UUCS facilities and accept responsibility for ensuring the building is secure when I leave the property.

Per UUCS policy, codes are only issued to members:
► with membership in good standing,
► have been members for a minimum of 1 year, and
► have a current background check on file

Name

This address will receive a confirmation email

Mobile Phone

Address

Reason for needing building access:

Please select one:

I have a current (in the last 3 years) background check on file. I need to have a background check and will contact the office to schedule an appointment to fill out the consent form. I don't know if I have a background check. Please let me know.

Key Box Codes:

I agree to the following when taking possession of, and responsibility for, the keys to the UUCS facility. Please check EACH BOX as read.

While on UUCS property, I may carry the keys from the key boxes on my person. I agree to only access the UUCS facility when acting under the auspices of UUCS. At no time will I access the keys for any purpose other than to fulfill an obligation or purpose for UUCS. I *will not* loan, transfer, give possession of, misuse, modify, or alter the keys. I *will not* cause, allow, or contribute to the making of any unauthorized copies of the keys. If I lose the keys, or they are not returned to the key box(es), I understand that I may be charged for the replacement of the keys and/or any necessary rekeying of the building. I will not share the codes for the key boxes with other members or visitors.

If you do not already have the key box codes, contact the office to schedule and appointment to have them issued to you.

Codes are not distributed via email.

Security Alarm:

I agree to the following with regards to the alarm system. Please check EACH BOX as read.

I *will not* share my alarm code with any other members or visitors of UUCS. If I am the one who opened the building, I take responsibility for ensuring that the building is secured (locked and closed) before I depart, or ... if the building is in use by another person or party, I will identify who will be taking over the responsibility for securing the building.

Each individual will have their own code for arming and disarming the alarm. Please enter a 4 digit number for your alarm code:

Your alarm code IS NOT ACTIVE until you receive an email from the Office Manager stating that it has been entered into the system.

The automatic confirmation email of the form submission is NOT a confirmation of your alarm code being programmed and ready for use.

Please check EACH BOX as read:

I understand that this form does not immediately program my code for use. I will not attempt to use my code until receiving a confirmation email from office@uusalem.org stating that it is ready for use.

Signature

By selecting the "I Accept" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting "I Accept" you consent to be legally bound by this Agreement's terms and conditions.

Please select one:

I Accept I will contact the office to schedule an appointment to sign in person.

Alarm and Key Code Request form

Description

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