Our Family Plan

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Evacuation Level: _____

• Where we’ll go if/when we need to evacuate.___________________________
  
• Will I go to a host home?  ___ Yes ___ No
  If Yes, list name, address and phone #: _______________________________
  
  
• Does my employer provide a special shelter for me and my family?
  ___ Yes ___ No     
  If Yes, list address and phone #: _______________________________
  
  ___________________________________________________________
  
  
• Will I go to a hotel/motel?  ___ Yes ___ No
  Do they accept pets? ___ Yes ___ No
  If Yes, list name, address and phone #: _________________________
  __________________________________________________________
  
  
• If required, have I registered for Special Needs Evacuation Assistance?
  ___ Yes ___ No

• My pet(s) name/type of pet(s) _________________________________

• What will I do with my pet(s) if I stay home? _____________________

   _____________________________________________________________
   

• What will I do with my pet(s) if I evacuate? ______________________

   _____________________________________________________________

• How will I secure my boat? ____________________________________
  
  
• Can I be a host home?  ___ Yes ___ No
  If Yes, how many/who will I host? ______________________________
  ___________________________________________________________
  
  
• What preventative measures will I take to safeguard my home?
  ___________________________________________________________
  ___________________________________________________________

• Window/door protection arranged? ___ Yes ___ No
• Are important papers copied and originals placed, with valuables,
  in a waterproof, safe place?  ___ Yes ___ No
  Location: __________________________________________________
• Copies placed: _____________________________________________
• Safe room identified? ___ Yes ___ No
  Location: __________________________________________________
• Have I obtained the elements of my survival kit? ___ Yes ___ No

Company & Policy #/Phone #

Home Owner’s SS#: _____________________________________________
Renter’s Insurance: _____________________________________________
Health Insurance: _______________________________________________
Flood Insurance: ________________________________________________
Auto Insurance: ________________________________________________

Name /Phone #
Doctor: ________________________________________________________
Dentist: ________________________________________________________
School(s): ______________________________________________________
Day Care: ______________________________________________________
Family and friends to notify of our plans:_____________________________

_______________________________________________________________

_______________________________________________________________


Central Family Contact: ___________________________________________

_______________________________________________________________

_______________________________________________________________