HCP4 2025 STEAR FORM Logo
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  • 2025 State of Texas Emergency Assistance Registry (STEAR)

  • STEAR Individual Registration Form

    Not for use by assisted living facilities or nursing homes. That form can be found at stear.texas.gov One (1) form should be completed for reach registrant. If you are getting assistance filling out this form, please have the person assisting you fill out the following:

  • **By registering in STEAR you are consenting to sharing your information with first responders and other state agencies during a disaster. **

    Please understand that the Emergency Assistance Registry assists emergency officials in planning for emergency events. Having your information helps to determine what kinds of services might be required during a disaster and helps responders plan and train more effectively. Communities use the information in different ways, so realize that having your information in the registry DOES NOT guarantee that you will receive a specific service during an emergency. Registration is not a substitute for developing and maintaining your own family disaster plan.

    Last-minute enrollments during a disaster event may not immediately reach your local emergency management office. For more information on local participation in STEAR, contact your local office of emergency management.

    We would like to gather some basic information from you. To be registered, some basic information is required. If filling out a paper form, please write the registrant's name in the designated space at the bottom of every page of the form.

  • Basic Registrant Information-Required information marked with red*

  •  State of Texas Emergency Assistance

    Registry Individual Registration Form TDEM 25

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  • Basic Registrant Information

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  • Emergency Contact Information

    In these questions, emergencies are defined as hazards to public health and safety, such as hurricanes, tornadoes, terrorist attacks, chemical accidents, and other disasters that may cause death, injury, or damage, which could require evacuations and sheltering of the public. We need to gather some information about the best person for emergency planners to contact in case of an emergency below.

  •  State of Texas Emergency Assistance

    Registry Individual Registration Form TDEM 25

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  • Caregivers and Animals

  • Emergency Warnings and Instructions

  •  State of Texas Emergency Assistance

    Registry Individual Registration Form TDEM 25

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  • Transportation Assistance

  • Medically Fragile

  •  State of Texas Emergency Assistance

    Registry Individual Registration Form TDEM 25

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  • Functional Needs

  • 28b. (If answered "Yes to Q28a), Please record the service provider and their contact information here

  •  State of Texas Emergency Assistance

    Registry Individual Registration Form TDEM 25

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  • 2025 State of Texas Emergency Assistance Registry (STEAR)

  • Section I: HCP4 STEAR Acknowledgement 

    By filling out this form, you consent to allowing Harris County to register you in the STEAR program and to use your personal information for Harris County services. The Emergency Assistance Registry assists emergency officials in planning for emergency events. Having your information helps to determine what kinds of services might be required during a disaster and helps responders plan and train more effectively.

    Your participation in the registry DOES NOT guarantee that you will receive a specific service during an emergency. Registration is not a substitute for developing and maintaining your own family disaster plan. Last-minute enrollments during a disaster event may not immediately reach your local emergency management office. For more information on local participation in STEAR, contact your local office of emergency management.

    If filling out a paper form, please write the registrant’s name in the designated space at the bottom of every page of the form.

  • Click this Button to Email Completed electronic form to STEAR@tdem.texas.gov

    This form can be filled electronically using Adobe Reader or Adobe Acrobat. When filled electronically, click above button to send. If you have trouble sending form electronically, Complete form and save to desktop as a uniquely named PDF file. (Example name: StearlndividualForm_uniquename_date.pdf Then attach PDF to an email and send to STEAR@tdem.texas.gov.

    Complete form, print, and then fax paper form to (866) 557-1074. *Please fill out and submit a new form if any of the information above changes.

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  •  State of Texas Emergency Assistance

    Registry Individual Registration Form TDEM 25

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