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Bridge Creek Fire Protection District
HOME
ABOUT US
History
Fire Stations
Apparatus
Meet The Fire Chief
FIRE & LIFE SAFETY
Safety Tip Sheets
Controlled Burns
Storm Shelter / Safe Room
>
Storm Shelter Registration
PHOTO GALLERY
LINKS
BECOME A VOLUNTEER
CONTACT US
Storm Shelter Registration
*
Indicates required field
Name
*
First
Last
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Home Phone Number
*
Work Phone Number
*
Type of Shelter
*
In Ground
Safe Room
Basement
Other (describe in comments)
Type of Shelter Comments
*
Any children stay at home alone?
*
Yes
No
If yes, please include the name and age of each child below.
Name
*
Age
*
Name
*
Age
*
Name
*
Age
*
Name
*
Age
*
Emergency Contact
*
Phone Number
*
GPS Location
*
Enter the GPS LAT & LON if you know them!
Emergency Contact
*
Phone Number
*
Exact directions to home from Bridge Creek Fire Station #1
*
Exact location of cellar/safe room from the driveway of home
*
By signing below, I understand by registering my cellar/safe room with the Bridge Creek Fire Department, that my cellar/safe room will be checked for entrapment by debris, after a tornado. I understand that my cellar/safe room 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 of the emergency, before I can be rescued from my cellar/safe room. I understand that I need to keep my cellar/safe room stocked with survival supplies and have been given a suggestion list by the registrar. With my signature, I release the Bridge Creek Fire Department and Bridge Creek Fire Protection District from any liability, for any event that occurs due to delayed rescue.
E-Signature
*
Type your full name
Date
*
Submit
Storm Shelter Printable Registration Form
File Size:
21 kb
File Type:
doc
Download File
HOME
ABOUT US
History
Fire Stations
Apparatus
Meet The Fire Chief
FIRE & LIFE SAFETY
Safety Tip Sheets
Controlled Burns
Storm Shelter / Safe Room
>
Storm Shelter Registration
PHOTO GALLERY
LINKS
BECOME A VOLUNTEER
CONTACT US