Shelter Registration Form

Company Name:  (If the place you are registering is a residence, please leave this field blank.)

First Name:

Last Name:

Phone:

Email:

Address:

Street:

Unit #:  (if applicable)

Zip:

The address being registered has the following: (check all that apply)
Basement
Below Ground Shelter
Above Ground Hardened Shelter

The basement or shelter is accessed: (check all that apply)
Inside Main Structure
Outside Main Structure

Location:
(beneath garage floor; backyard 10ft from back door; above ground shelter in center of house, etc.)

GPS Coordinates:
(this needs to be the coordinates of the entrance. LAT / LONG)

SIGNATURE
 
By signing below, I understand by registering my basement, underground storm shelter, or hardened above ground storm shelter, that those areas may be checked for entrapment by debris, following a severe tornadic event. I further understand that it may be an undetermined amount of time, depending on the size of the emergency, before a rescue attempt may be initiated at my location. With my signature, I release Hockley County and the Hockley County Amateur Radio Club from any liability, for any event that occurs due to delayed rescue. I further acknowledge that any record created is subject to the Texas Public Information Act.
Signature: (type full name)