Lake Marion Ward Emergency Prep Resources
Ward Members with Special Skills, Resources, and/or Needs
Primary Contact Person of Your Home
First Name
Last Name
Secondary Contact Person of Your Home
First Name
Last Name
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Email
example@example.com
Secondary Email
example@example.com
Primary Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Secondary Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Number of Adults in the Home
Number of Children in the Home
In case of an emergency, please list any medical needs or physical limitations of members in your home.
What special skills or training would you be willing to share in case of an emergency? Please only select skills or training with which you are confident in your ability to help in emergency situations.
Plumbing
Electrical
Carpentry
Welding/Metallurgy
Medical Training
HVAC
Auto Mechanics
Sewing/Tailoring
Multilingual (Please Specify Below)
Construction
HAZMAT
Gardening
Food/Water Storage
Military/Survival Training
Self Defense Training
Firearm Safety
Other
If you selected “other” or would like to add any additional special skills or training, please do so here.
Please select any resources you have access to that you would be willing to share or lend in case of an emergency.
Power Tools (Please Specify Below)
Hand Tools (Please Specify Below)
Lawn Mower
Snow Blower
Snow Shovels
ATV/UTV
Pickup Truck or Flatbed
Heavy Equipment (Please Specify Below)
Trailer (Please Specify Below)
Snow Mobile
Sewing Machine
Firewood
Outdoor Cooking Gear
Camping Gear
Medical Equipment (Crutches, Wheelchair, etc.)
Ham Radio
2-Way Radio
Power Generator (Please Specify Below)
Other
If you selected “other” or would like to add any additional information, please do so here.
Please use this space for any additional comments.
Submit
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