Join the Network

Austin Disaster Relief Network - Registration Form

Thank you for joining the Austin Disaster Relief Network! Please take the next 5-10 minutes to fill out the following form completely. This will give us vital information needed to register you properly. After completing the form, instructions will be given to you on your next steps. We look forward to working with you soon. God bless!

Sincerely,

Daniel Geraci
ADRN Director

Note: This form is not for volunteers but church leaders only. To find the Volunteer Registration page, click on the "Volunteer Registration" button on the right side of this page.

Contact Information Section

*Church, Ministry or Business Name

*First Name

*Last Name

*Title

*Cell Phone Number

*Phone Number

*Email Address

*Street Address (no PO BOX please)

*City

*State

*Zip Code

*Your Pastors Name

*Your Church Name

*Disaster Relief Contact (DRC) at Church/Ministry/Business

*Disaster Relief Contact Cell Number

*Disaster Relief Contact Email Address

THIS SECTION FOR: CHURCH ONLY

(if ministry or business, scroll down)

The next section of this form will help Austin Disaster Relief Network (ADRN) understand "the big picture" of available resources we have within Greater Austin.

How many members do you have in your church (approximate)?

Is your church community bilingual?

Is your organization interested in adopting a city emergency shelter close to your facility?

In the event of a catastrophic disaster, how much space can you designate for evacuees within your church facility?

If needed, how much space can you designate for storage within your church facility (i.e. food, clothing, supplies, etc..)?

Do you have food preparation/serving capabilities?

Do you have showers within your facility?

If your answer is "no", are you close to a YMCA or facility with showers?

Is your facility ADA compliant?

Please give an approximate number of volunteers you can commit to help with local ministries, city of Austin, Red Cross or other disaster relief organizations.

Would you like your prayer team updated on prayer points for the relief effort?

If yes, please give us the First and Last name of your prayer leader:

Prayer Leader Email Address

Prayer Leader Cell or Home number

THIS SECTION FOR: MINISTRY/BUSINESS/CHURCH

The next section of this form is very important. It will help ADRN understand "the big picture" of available resources we have within the city.

Of the following 6 categories: Food, Clothing, Shelter, Warehouse, Transportation, and Furniture, which categories can you provide services in?

Food Shelter Transportation

Clothing Warehouse Furniture

Please give ADRN an approximate inventory of what you can provide in the area of FOOD (i.e. 30 lbs of red meat, 100 lbs of chicken, etc.. ) - if "none" - please type NONE.

Please give ADRN an approximate inventory of what you can provide in the area of CLOTHING (i.e. adult men and women's clothing, children's clothing from infant to 3 yrs of age) - if "none" - please type NONE.

Please give ADRN an approximate inventory of what you can provide in the area of SHELTER (i.e. 2 houses for men with 4 rooms each, unisex shelter for 150 people, and/or 10 apartments, 20 hotel rooms, etc..) - if "none" - please type NONE.

Please give ADRN an approximate inventory of what you can provide in the area of TRANSPORTATION (i.e. Transportation: "6 school buses, 3 full size vans, 2 full size 26" moving trucks, etc..) - if "none" - please type NONE.

Please give ADRN an approximate inventory of what you can provide in the area of WAREHOUSE space (i.e. 10,000 sq. ft. of storage for 3 months, 15,000 sq. ft. for storage) - if "none" - please type NONE.

Please give ADRN an approximate inventory of what you can provide in the area of FURNITURE (i.e. 5 kitchen tables, 3 sofa's, 15 queen size beds, etc..) - if "none" - please type NONE.

*Required