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Water Sampling Registration
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City of Beaumont Water Sampling Form
Unique Registration Code
Your unique code can be found on the direct mailer that you received.
Does your household water system currently have a reverse osmosis system or water softener connected?
Contact Phone Number:
Alternate Phone Number:
Electronic Signature Agreement
By checking the "I agree" box below, you agree and acknowledge that:
1) your registration will not be signed in the sense of a traditional paper document;
2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and
3) you may still be required to provide a traditional signature at a later date.
If you have questions contact:
City of Beaumont
The personal information requested on this form is being collected under the authority of the City of Beaumont Bylaw 382 and Section 33(c) of the Freedom of Information and Protection of Privacy (FOIP) Act. The information collected will be used for the purpose of registering your home for the Water Quality Sampling Program .
If you have any questions about the collection or use of your personal information, contact the City of Beaumont’s FOIP Coordinator at:
City of Beaumont's FOIP Coordinator
Beaumont, AB T4X 1A1
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