*** Public Help and Distress (SOS) Form - False Calls will be Handled as False 911 Calls and will be Sent to the Police to Follow up on and to Enforce Criminal Actions ***
Personal Information
First Name:
*
Last Name:
*
Email Address:
Contact Phone:
*
Backup Phone:
Requirements
Imminent Danger of Death ?:
No
Yes
Do You Have Power ?:
No
Yes
Do You Have Water ?:
No
Yes
Do You Have Food ?:
No
Yes
Do You Have Significant Health Conditions ?:
No
Yes
Unknown
Adults:
Children:
Elderly:
Pets / Livestock ?:
No
Yes
Livestock Info:
Type of Rescue ?:
Select One
Air Rescue
Ground Rescue
Medical Rescue
Water Rescue
Wellness Check
Location
Street Address:
City:
State:
Postcode:
Other Info:
Submit
Cancel
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