Emergency Preparedness Form | 980 North Vfd

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Emergency Preparedness Form

Complete the form below so the 980 North VFD can be better prepared to assist you.

Occupancy

Please take a moment to fill out the form.

First Name (Optional)

Last Name (Optional)

Address

Phone

Email

How Many Residents have Medical Equipment which requires a power source?

How Many Residents Over 65?

How Many Residents whom require assistance exiting home?

Do you have a propane tank on your property? *

Yes

No

List Medication and/or Allergies:

Thanks for submitting!

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