Resident Sign Up - Flood 2019
West Carleton Disaster Relief is advocating on behalf of all West Carleton's flood-affected residents. It is important to us that governments and agencies understand the specific impacts in our community and that their programming reflects the actual needs of affected residents.

This survey is for affected residents to ensure that you are aware of the services, programs, and agencies that may be available to help and that all residents at risk have access to up-to-date information on the flood risk, flooding, flood prevention, and recovery.

If you would like to be on our contact list for the upcoming highwater season or you are struggling to recover please fill out the required information below. Even if you do not need assistance please let us know so we can focus on neighbours who may not be doing as well.  

If you are still recovering or facing issues you will have the opportunity at the end of this survey to agree for us to share your information with other agencies who may be able to help you, without agreeing below WCDR will not share any non-aggregate data.
If you have any questions please email

You have a choice below to sign up for our email lists, you will be able to unsubscribe at any time.

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Email *
First Name *
Last Name *
Street Number *
Street Name *
Phone Number
Property Ownership
If you own more than one property please tell us about them in separate forms.
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Number of Adults in Home
Number of Children Age 0-9 in Home
Number of Children 10-18 in Home
Number of Seniors In Home, 65+
Number of Household Members with Disabilities or Critical Health Issues
Number of Household Members with Mobility Issues
Home Based Business
Do you run a business from your home?
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Please confirm that you would like to receive emails regarding flood preparation and the upcoming spring freshet? *
Including meetings and information from utilities, governments, and authorities regarding preparing for and dealing with floods. You can unsubscribe at any time.
Would you be interested in a buyout if the province offered one?
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Are you still recovering from flooding?
Please answer as many questions below as you are comfortable with.
Would you like to receive separate emails regarding recovery? *
If you choose no, you will not receive updates regarding, meetings, programs, funding, volunteer availability etc. related to flood recovery, repairs and rebuilding.
How long were you or your tenant evacuated from the property?
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Did you have water damage to main living areas?
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Did you have water damage to a finished basement?
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Did you have water damage to an unfinished basement or crawlspace?
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Do you have structural damage?
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Did you have damage to your home systems?
Furnace, Electrical, Hot water heater, etc.
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Are you considering raising your building to reduce the of future risk of future flooding?
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Have you started with your essential repairs?
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What is the extent of the work to be completed?
Funding Sources
Please indicate which of these funding options you have applied for.
Funding approved or received
Funding scenarios
Do one of these funding scenarios describe your situation?
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Do you fall into one of these yearly income categories?
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I would like to be referred to programs for stress, mental health and wellness?
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Would you attend recovery meetings?
We hosted regular residents meetings to discuss DRAO, repairs and rebuilding. Would you attend monthly residents meetings if WCDR hosted them again?
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Please tell us more about your situation and needs
I consent to WCDR sharing my information as outlined. *
Please remember that due to privacy laws the initial responding agencies, even in an emergency, are unable to share your information. The information you shared with the Canadian Red Cross (“CRC”), the city or other agencies is not able to be passed on.  West Carleton Disaster Relief Association (“WCDR”) will not release information on this form or other personal information you provide us to any external individual or group without your permission. Your personal information will be restricted within WCDR to volunteers who explicitly need it to provide updates, products, or services.  WCDR works with the CRC and other charitable organizations to make them aware of community needs and to connect families with information or services.  As such, we are seeking your authorization to share information about your case files between the organizations for the purpose of assisting you with information or services and/or producing relevant statistics. No part of your information will be disclosed for any other purpose, to any government, realtor, or commercial interest without your explicit consent. By signing this form, you authorize WCDR, the CRC, and other charitable organizations to release to or obtain from each other any and all pertinent information that may be necessary to facilitate your assistance. This allows the CRC to communicate to WCDR, and vice versa, your personal information.
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