First Responder Annual Registration Form
First Responder Entity Information and Contacts:
Organization
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Organization Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Contact Person
First Name
Last Name
Contact Person Title
Contact Person Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Contact Person Email
example@example.com
Second Contact Person
First Name
Last Name
Second Contact Person Title
Second Contact Person Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Second Contract Person Email
example@example.com
Organization Capacity:
Is your organization a 501c3?
Yes
No
Are you able to pay to use vacant property temporarily for training exercises?
Yes
No
Can your organization supply a Certificate of Insurance?
Yes
No
First Responder Preferred Property Use:
Are you seeking use of properties? (check all that apply)
Non-Invasive
Invasive
Does your organization train with animals (K9)?
Yes
No
What is the typical duration of your training exercise? How long would you seek to use the property? (check all that apply)
Training occurs over the course of one day
Training occurs over the course of several consecutive days
Training occurs over the course of a week consecutive
Training occurs over the course of a month consecutive or non-consecutive
Does your organization train in the daytime, nighttime, or both?
Daytime
Nighttime
Both
What type of structures does your organization seek to use for training? (check all that apply)
Single family residential
Multi-family residential
Office building
Industrial building
Ground*
*If selected Ground, please define minimum amount of acres needed for training:
What type of amenities does your training REQUIRE? (check all that apply)
Working bathroom(s)
Electricity accessibility
Portable water
Parking*
*If selected Parking, please define minimum number of parking spaces needed for training:
Any additional considerations you want listed on the registry for property owners to know before contacting you?
Signature
Name
First Name
Last Name
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Continue
Continue
Should be Empty: