Do you currently receive emergency alerts or other community preparedness information?
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If yes, where do receive your information (check all that apply)?
How would you seek information before or after a climate event (check all that apply) ?
Does your household have a "Go Bag" (a collection of things you would want if you have to leave in a hurry) or an emergency kit?
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Does your household have a preparedness plan in the event of a disaster?
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If Yes, what is the plan?
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Do you know where the nearest local emergency shelter is located to your household?
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If yes, please indicate
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Does your household have air conditioning?
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Does your household have heating?
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Do you know where your nearest local cooling center is located?
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If yes, please indicate
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Does your household include any of the following:
Do you or a member of your household have a disability or another limitation that might make evacuation difficult?
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If yes, please explain
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Are there critical, life threatening supplies that your household would need access to immediately in the event of a climate event (i.e., asthma inhaler, formula, diapers, medicine, etc. ?
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If yes, please explain
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If yes, do any of these supplies rely on electricity?
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Please list the names of any local organizations that you would turn to in the event of a climate event.
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Would you be interested in becoming a registered BaB Volunteer?
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If yes, please provide your email address
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Would you like a someone from the BaB to call and check in with you during an emergency climate event?
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If yes, please provide your phone number
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Please add any additional information that you would like to share
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