[Name of Group] COPE Questionnaire
Thank you for filling out this questionnaire. As neighbors watching out for our neighbors, we hope to organize the critical contact and basic resident information in a way to support us in an emergency situation.

The information is kept CONFIDENTIAL and will serve to inform organizers and/or emergency personnel, of who resides or works within a neighborhood, and of special circumstances or resources that would help keep people and properties safe in the event of an emergency.
Email address *
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