Flood Impact Assessment Form
Member Zone
Please Select
North Coast Football
Football Far North Coast
Club Name
*
Club Contact
*
First Name
Last Name
Email
*
example@example.com
Phone
*
Has your facility sustained flood damage?
*
Please Select
Yes
No
Have your fields been inundated?
*
Please Select
Yes
No
Has your clubhouse been inundated?
*
Please Select
Yes
No
Have your changerooms been inundated?
*
Please Select
Yes
No
Have the fields lighting been damaged?
*
Please Select
Yes
No
Have any storage areas been inundated?
Please Select
Yes
No
Has any club machinery been damaged?
*
Please Select
Yes
No
Estimated cost of flood damage. (if known)
Any additional information
eg: fencing damaged. fridges & freezers damaged. council assessing damage. electricity issues. etc.
Submit
Should be Empty: