Rescue Request Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Rescue Request Form

Fill this form out if you are in need of a rescue. We will send help, as soon as possible.

By filling out this form, you are requesting independent volunteers to come help you, your family, and your pets, to safety. We are a civilian volunteer team, neighbors helping neighbors and their pets. Many of our volunteers have extensive training and experience in disaster response and some are your neighbors who saw a need and a way to help. We have systems in place to respond in an efficient manner.

Always try 911 first. We volunteer because we know, during a disaster, the 911 system can get overwhelmed with calls, and people can't get thru.

You may submit this form, on behalf of someone else, but we need to have valid information. If you found this info on social media, PLEASE be sure to include a link to the original request below. If we can not verify the information provided, we may not have the resources to respond.

What County are you in? *

City *

Street Address *

Zip Code *

Phone Number: *

Name: *

Please provide a brief description of your need: *

Please let us know what pets you need us to evacuate, where they are, and any special instructions

Do you need assistance to evacuate yourself and/or your family? If yes, please let us know how many people (adults and children)

Please let us know f there are any dangers, that you are aware of, that could make it dangerous to travel to your front door. (Road closed, flooded front yard, fire is now in your neighborhood)

Do you give us permission to gain access into your home or property? *

Yes

If you are requesting rescue, on behalf of someone else, what is your name:

If you are requesting rescue, on behalf of someone else, what is your phone number?

If you found this request on the internet, provide a link to request here:

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Forms