Most fields are required because we feel they're essential for your plan.
Email address *
What do you want to call your household? *
(e.g., "The Tanners") -- capitalize text as you'd want it to appear
Your answer
Kid(s) names (write as you'd want them to appear)
(for more than one kid, simply list them in order - separated by commas)
Your answer
Your Address *
(write exactly as you'd like to appear)
Your answer
Your cross streets *
Your answer
Neighborhood Name *
(what is your neighborhood called? This is sometimes helpful for emergency calls)
Your answer
Pets?
Pet-related instructions for a home evacuation (like a fire)
60 Characters maximum (e.g., Call "MONDO" loudly to have dog follow you, no leash needed) LEAVE BLANK IF YOU DON'T HAVE PETS!
Your answer
Name of Parent or Guardian #1 *
(this should be the name of the person filling out this form)
Your answer
Mobile # *
Your answer
Describe in a few words where this person works
(e.g., "works at Good Day San Francisco news studio - 3 miles away")
Your answer
Name of Parent or Guardian #2
Your answer
Mobile Number
for Parent/Guardian #2
Your answer
Email
for Parent/Guardian #2
Your answer
Describe in a few words where this person works
for Parent/Guardian #2 (e.g., "works at the Smash Club - 2 miles away")
Your answer
Name of Local Emergency Contact #1 *
(a friend or family member)
Your answer
Mobile Number *
(for Local Emergency Contact #1)
Your answer
What's their relationship to your family? *
for Emergency Contact #1 (E.g., Friend of the Family)
Your answer
Name of Local Emergency Contact #2
Your answer
Mobile Number
(for Local Emergency Contact #2)
Your answer
What's their relationship to your family?
(Local Emergency Contact #2)
Your answer
Name of an Out-of-State Contact *
(During natural disasters, local calls can disconnect)
Your answer
Mobile Number *
(for Out-of-State Contact)
Your answer
What's their relationship to your family? *
(for Out-of-State Contact)
Your answer
Describe the location of 1-2 fire extinguishers in your home. *
Write in a brief sentence (e.g., "In the kitchen: in cabinet below the coffee machine & In the entryway closet: bottom right-hand corner.") tip: If you don't have one yet, write where you WILL put it, then go buy one :) - Max Characters: 155
Your answer
Describe the location of your first aid kit/emergency supplies. *
Include some detail about what's in the kit (e.g., Bright red backpack on hook in hallway closet: first aid supplies and emergency equipment like flashlights, radio, walkie talkies) tip: If you don't have yet, write where you WILL put it, then get to it. We have suggestions on what to include - http://www.famdisasterprep.com/disaster-supply-list.html
Your answer
Describe the location of your emergency water supply. *
(e.g., On the floor of the hall closet: 3 gallons of water)tip: If you don't have water yet, write where you WILL put it, then go buy some :)
Your answer
Describe how to turn off the gas line in your building / home *
(e.g., "Behind the building: The gas shut off valve is on the wall near the street door, and we keep a wrench there for turning the valve. There is a main water shut off valve in the same area.")Tip: if you are a renter, ask your landlord. This is a required question because it's really important to know!
Your answer
Name and Address of the nearest Emergency Room *
(Tip: call your pediatrician to ask their advice on the best nearby pediatric emergency center)
Your answer
Decide on an Emergency Meetup Spot *
(note: this will be use in the case of an emergency in your home, so make sure it's walking distance as people may have had to evacuate quickly. It could be a neighbor's house, a playground, a restaurant, et al)
Your answer
Meet up Spot Address
Your answer
Describe the location / direction of your meetup spot
Max character count: 100
Your answer
Safest Places During an Earthquake - Throughout Your House
Did you know.... it’s actually a myth that standing in a doorway is the safest place to be?

-- It’s technically not any more sturdy than most other places in the house
-- You should never remain standing
-- The best place to be is on the ground, away from falling objects or broken glass. If you have a table in a room, the safest place is likely underneath that table
-- In some rooms, the safest place may in fact be crouching in a doorway, but it's likely because you will avoid falling objects. Not because it's sturdy on its own

Describe a good earthquake plan for your Living Room
(e.g., "Get heads under coffee table, scoot away from the window once you are under table / hold on.")
Your answer
Describe a good earthquake plan for your Kitchen
(e.g., near entry, scoot away from window & hanging pans)
Your answer
Describe a good earthquake plan for your bathroom
(e.g., near door, scoot away from mirror and window)
Your answer
Enter the name of another common room in your home.
(e.g., kid's bedroom)
Your answer
Describe a good earthquake plan for the above room.
(e.g., in the corner, away from the ceiling light fixture and bookshelf)
Your answer
Enter the name of another common room in your home.
Your answer
Describe a good earthquake plan for the above room.
Your answer
Enter the name of another common room in your home.
Your answer
Describe a good earthquake plan for the above room.
Your answer
Figure out what's the best local radio station to tune in for emergency broadcasts
AM radio stations have a much longer range than FM stations, which are higher frequency and tend to be more localized. The most hardcore survivalists buy an NOAA radio for their Disaster Kit. This has the lowest frequency (meaning.... the best range), so is the best possible way to ensure you hear news from emergency authorities.

Here are a few AM radio stations on the West Coast to help you out (not a great database for this online):

- San Francisco Bay Area: KGO 810 AM , KCBS 740 AM or KNBR 680 AM
- Los Angeles Area: KNX 1070 AM
- Seattle Area: KIRO 710 AM, KOMO 1000 AM
- Portland Area: KOAC 550 AM, KEX 1190 AM

What's the best AM radio station in your area for emergency broadcasts? *
Your answer
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