Bolton Neighbor to Neighbor Emergency Needs Survey
The purpose of this survey is to give you a chance to indicate if you might need extra help during an emergency situation. Information collected will only used by emergency personnel and volunteers during an emergency. If you feel that you do NOT need any help, please just choose "No" in question number 2 and click submit.
1. Your Name and Address
Your answer
2. Does anyone in your household have a functional disability? If yes, please indicate what below.
3. Do you need power for any of the following?
4. Would you need help to evacuate your home?
5. Do you drive on your own (and have a car)?
6. Would you like a volunteer to check in on you during severe snow storms, power outages, or flood near your home?
7. Do you have a temporary situation coming up like surgery, chemo, etc. when you will need extra help? If so, when?
Your answer
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