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 *
Your answer
Cell phone number where you can be reached. *
Your answer
Email address where you can be reached. *
Your answer
Where are you currently living (conditions- i.e. friend's house, shelter tent, car, etc.) *
Your answer
Total number of people living in your household. *
Your answer
Total number of children in your household (under 18 years of age). *
Your answer
Total number of adults in your household (18 years and older). *
Your answer
Please list the ages and genders of everyone in your household (i.e. 2 month g, 4b, 18f, 28m) *
Your answer
Are you a single parent? *
Are you a first responder (firefighter, EMT, police)? *
Please describe your first responder work (we will request documentation).
Your answer
Are you a US military veteran? *
Please describe your military service (branch, dates, combat/deployment etc.).
Your answer
Do you have any serious medical conditions? If yes please describe. *
Your answer
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. *
Your answer
Please add anything else that you consider relevant to our evaluation of your application for a RV/ Travel Trailer. *
Your answer
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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