Contact Us
This contact form will provide basic information to the Washington County Long Term Recovery Group. Tell us about yourself. Your answers will help us determine how we can best help you. A member of our disaster case management team will contact you.
Sign in to Google to save your progress. Learn more
First Name *
Last Name *
Address *
City *
Zip Code *
Phone *
Provide a phone number that can be used to communicate with the WCLTRG.
Phone Label
What label describes the phone number you provided?
Clear selection
Email
Provide an email address that can be used to send and receive emails from the WCLTRG.
Residency *
Are you a resident of Washington county, Tennessee?
Property Ownership *
Are you the property owner?
Dwelling *
What type of home do you have?
Occupants *
How many people live on the property?
Home Count *
How many homes are located on the property?
Agreement *

Waiver to receive volunteer aid    I understand this form is neither a representation of aid nor a guarantee of aid. By signing this form, I agree to: 1. share contact information with the group and benefactors who coordinate and provide aid; 2. acknowledge there is value to the time, services, and materials provided by the group; 3. hold harmless the group (and its volunteers and affiliates) who provide labor services from damage or injury on the property; 4. release liability; 5. participate in the necessary processes to facilitate distribution of aid.

Required
Next
Clear form
Never submit passwords through Google Forms.
GoogleForms
This form was created inside of Washington County Long Term Recovery Group.