Safe Room Registration

 

First Name::
Last Name::
Address 1::
Address 2::
City::
Zip Code::
Type of Shelter {Safe Room, In Ground}::
Shelter Comments::
Exact location of your safe room / storm shelter from your driveway::
GPS Location::
Number of occupants normally in your shelter::
Please list any physical / mental challenges occupants of your shelter may have::
Emergency contact name of an occupant normally in your shelter::
Phone Number 1::
Phone Number 2::
Emergency contact name of someone off-site::
Phone Number 1::
Phone Number 2::
Emergency contact name of someone off-site::
Phone Number 1::
Phone Number 2::
Hospital you wish to be transported too, if needed::
E-Signature::
E-Signature Date::

 

 By signing the E-Signature, I understand by registering my safe room / storm shelter with the Rolling Hills Fire Protection District No. 1, that my safe room / storm shelter will be checked for entrapment by debris, after a tornado. I understand my safe room / storm shelter will be checked as quickly as manpower is available to perform such search and rescue. I further understand that it may be several hours, depending on the size and scope of the emergency, before I can be rescued from my safe room / storm shelter. I understand that I need to keep my safe room / storm shelter stocked with survival supplies including non-perishable foods and drinking water. With my E-Signature, I hereby release the Rolling Hills Fire Protection District No. 1 aka Rolling Hills Fire Department aka Rolling Hills Fire / Rescue from any and all liability for any event and/or delay in rescue.

© 2021 Rolling Hills Fire Protection District No. 1