It's Hurricane Season! Will you need help? Can you give help?
RequiredRequired Question(s)
We are concerned with your welfare and your personal situations.  We are also concerned about our church property, the community and other communities.  This survey will allow RPC to identify individuals that may need assistance and individuals that wish to volunteer their services.  All information provided will only be used in the event of an emergency.
 
1.

Do you have special needs that would require assistance to evacuate or get to a shelter and what would that assistance need to be?

Yes
No
  • Comment:

  • 500 characters left.
2.

Have you registered with the County to obtain assistance?

Yes
No
3.

If you are not registered, do you need help obtaining or filling out county paperwork?

Yes
No
4.

Will you need assistance preparing your property before a storm?

Yes
No
5.

Would you be able help other church members prepare their property or the church property as a storm approaches?

Yes
No
6.
Would you accept church families who may be required to evacuate?
If yes, please add the number of people you could accommodate in the comment field and  restrictions there might be.  
 no possibly yes   
Would you accept smokers?   
Would you accept pets?   
  • Comment:

  • 500 characters left.
7.

Would you be able to help other church members or the church property with after storm clean up?

Yes
No
8.

Do you have special equipment, which can be used if necessary?

truck
portable generator
chain saw
pump
travel trailer/RV
  • Comment:

  • 500 characters left.
9.

Do you have special training or special talents that can be utilized following a disaster?  Please list in the comments section.

Yes
No
  • Comment:

  • 500 characters left.
10.

Would you be interested in serving on the Riverside Presbyterian Church Disaster Preparedness Committee?  

Yes
No
Required 11.
Please enter the information indicated below.

First Name:
Last Name:
Home Phone:
Email Address:
emailaddress@xyz.com
Address 1:
City:
State/Province
(US/Canada):
Postal Code:
Are you a member of Riverside Presbyterian Church?:
Cell Phone:
Number of people at this address: