Family Intake Form -RV4CampfireFamily
This form will help us collect the information we need to add families to our waiting list for RV donations. Please keep in mind we are just a team of 5 volunteers doing the best we can! We are so sorry for everything you have been through and have lost. We may ask you to provide documentation to verify the information that you have provided so please be honest and truthful.
Name of head of household *
Cell phone number where you can be reached. *
Email address where you can be reached. *
Where are you currently living (conditions- i.e. friend's house, shelter tent, car, etc.) *
Total number of people living in your household. *
Total number of children in your household (under 18 years of age). *
Total number of adults in your household (18 years and older). *
Please list the ages and genders of everyone in your household (i.e. 2 month g, 4b, 18f, 28m) *
Are you a single parent? *
Are you a first responder (firefighter, EMT, police)? *
Please describe your first responder work (we will request documentation).
Are you a US military veteran? *
Please describe your military service (branch, dates, combat/deployment etc.).
Do you have any serious medical conditions? If yes please describe. *
Were you a renter or owner? *
Do you have insurance for your home? *
Please list the address (street name, number, city, zipcode) of the home that you lost in Campfire disaster. We may require that you provide a bill or piece of mail in your name to document this address. *
Please add anything else that you consider relevant to our evaluation of your application for a RV/ Travel Trailer. *
If we are able to secure a donation of a RV/Trailer/5th Wheel for your family, do you have somewhere that you can park it? *
Please advise your preference: *
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