STORM SHELTER ON-LINE REGISTRATION

Please complete and submit the application below. There is NO CHARGE for registering your storm shelter with the City of Grove. Your storm shelter location will be shared with Emergency Management.

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FORM TITLE

DATE

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FULL NAME *

Please include First and Last Name

ADDRESS *

CITY, STATE, ZIP *

LAND LINE PHONE NUMBER

Including Area Code (if applicable) AT LEAST ONE PHONE NUMBER MUST BE LISTED

CELL PHONE NUMBER

Including Area Code (if applicable)

AREA/SUB DIVISION OR ADDITION NAME

"OTHER" TYPE OF SHELTER

IF "OTHER" WAS CHOSEN AS YOUR TYPE OF SHELTER PLEASE DESCRIBE YOUR SHELTER

SHELTER LOCATION *

EXPLAIN WHERE ON YOUR PROPERTY YOUR STORM SHELTER IS LOCATED (i.e. under garage, s/w corner of house, n/e corner of yard, etc) Be as specific as possible.

NUMBER OF SHELTER USERS * Persons

Approximate number of family members or others who will be using this shelter

GPS COORDINATES OF YOUR SHELTER (IF KNOWN)

If you do not know the GPS point of your shelter the Grove 911 Coordinator will enter the approximate point according to the shelter location listed above.

SIGNATURE BOX *

Please include First and Last Name

AGREEMENT BOX *

I hereby certify the information provided is true and correct to the best of my knowledge. I understand that checking this box constitutes a legal signature.

STORM SHELTER ON-LINE REGISTRATION

Contact Information