Church Registration Form
This form is not for volunteers to complete, but church leaders only. Thank you.
Name of Church
*
Physical Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact Information
Contact Person
*
First Name
Last Name
Cell Phone Number
*
Please enter a valid phone number.
E-mail
*
example@example.com
Senior Pastor
*
First Name
Last Name
Cell Phone Number
*
Please enter a valid phone number.
E-mail
*
example@example.com
Prayer Leader
*
First Name
Last Name
Cell Phone Number
*
Please enter a valid phone number.
E-mail
*
example@example.com
Church Information
Crisis Coordinator (This is the contact point, whether interim or long-term)
*
First Name
Last Name
Cell Phone Number
*
Please enter a valid phone number.
E-mail
*
example@example.com
Church Attendance
*
Please Select
Under 50
50-250
250-750
750-2,000
over 2,000
In the event of a catastrophic event, how much space can you designate for storage within your facility (i.e. food, water, disaster supplies):
*
1,000 sq. ft. or less
1,001-5,000 sq. ft.
5,001-10,000 sq. ft.
Over 10,001 sq. ft.
None
In you have over 5,000 sq. ft. of available space, would you be interested in finding out more about becoming a Red Cross approved shelter?
Yes
No
Do you have food preparation/serving facilities?
*
Yes, I have a small kitchen
Yes, I have a full-size commercial kitchen
No
Do you have showers within your facility that the public can use in the event of an emergency?
*
Yes
No
Are you close to a YMCA or a facility with showers (gym)?
*
Yes
No
Is your facility ADA compliant?
*
Yes
No
Which of the following areas can the church provide services in a time of crisis?
*
Food Ministry
Clothing Ministry
Warehouse Space
Transportation (i.e. church vans, church buses)
None
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*
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