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Sample Contact Us Form
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Sample Home Assessment Request Form
Sample Resident Registration Form
Sample Volunteer Opportunity Form
Sample Volunteer Submission Form
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Sample Volunteer Submission Form
This sample form will reside and function differently depending on the Package.
This is a sample form and therefore not functional.
Name
(Required)
First
Last
Email
(Required)
Enter Email
Confirm Email
Phone
(Required)
Address
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Home Owner or Renter?
(Required)
Home Owner
Renter
Management Company
None of the above
HOA (ABC City, CA Residents)
Please select your Home Owner's Association (HOA). If you do not have one or are not sure of your HOA, please select "No HOA." If your HOA is not listed here, please let us know the name of your HOA using the "Notes" field below.
HOA 1
HOA 2
HOA 3
Community A
Community B
Community C
No HOA
Volunteer Activity To Record
I have completed the following volunteer activities needed by my community to achieve or maintain Firewise status. (You may choose more than one). When you select an activity, a "Please enter ACTIVITY completed" section that will be added after your selection. Please use the dropdown or field of this activity section to record your activity. For the "Resident Structural Work,” “Resident Yard Work,” and HOA activities, please select volunteer hours completed, AND/OR if you paid a 3rd Party to do the work for you, please select the appropriate “Resident Structural 3rd Party Payments,” "Resident Yard Work 3rd Party Payments,” or “HOA Work 3rd Party Payments" categories and enter the dollar amounts spent on materials or services to improve your residence, HOA, or defensible space. Each $29.95 spent is converted to one Volunteer Hour to help meet your Firewise Community goals.
Resident Structural Work Hours
Resident Structural Work 3rd Party Payments
Resident Yard Work Hours
Resident Yard Work 3rd Party Payments
Home Assessment Hours
Community Team Leader Hours
Community Events Hours
Communications Hours
Fundraising Hours
IT Assistant Hours
Board Member Hours
HOA Work Hours
HOA Work 3rd Party Payments
Watch Video Hours
Read Document Hours
Other Hours
Please enter RESIDENT STRUCTURAL HOURS completed
(Required)
Please use drop down to enter hours completed. If you completed more than the allotted hours, please resubmit another form.
1 Hour
2 Hours
3 Hours
4 Hours
5 Hours
6 Hours
7 Hours
8 Hours
9 Hours
10 Hours
Please enter RESIDENT STRUCTURE MONEY PAID to 3rd parties
(Required)
If you paid someone else to complete recommended RESIDENCE STRUCTURE work on your behalf to harden your residence against wildfire, please enter the amount paid.
Please enter HOME YARD WORK HOURS completed by you the RESIDENT
(Required)
Please use drop down to enter hours completed. If you completed more than the allotted hours, please resubmit another form.
1 Hour
2 Hours
3 Hours
4 Hours
5 Hours
6 Hours
7 Hours
8 Hours
9 Hours
10 Hours
Please enter MONEY PAID to 3rd PARTY for HOME YARD WORK
(Required)
If you paid someone else to complete recommended RESIDENCE YARD work on your behalf to harden your residence against wildfire, please enter the amount paid.
Did you the RESIDENT remove vegetation from your yard?
(Required)
The amount of any vegetation removed is required for Firewise recognition.
Yes
No
Did a 3rd PARTY remove vegetation from your yard?
(Required)
The amount of any vegetation removed is required for Firewise recognition.
Yes
No
Type of RESIDENT Clearing Container Used
Please select from the five sizes of containers below, and use the dropdown to select the amount of containers used.
Lawn and Leaf Bag
Yard Waste Bin
Pickup Truck
Dump Truck
Roll Off Dumpster/Container
Type of 3rd PARTY Clearing Container Used
Please select from the five sizes of containers below, and use the dropdown to select the amount of containers used.
Lawn and Leaf Bag
Yard Waste Bin
Pickup Truck
Dump Truck
Roll Off Dumpster/Container
Lawn and Leaf Bags Removed by RESIDENT
Please use drop-down to select approximate amount of Lawn and Leaf Bags of vegetation removed by
RESIDENT
.
1 Lawn and Leaf Bag
2 Lawn and Leaf Bags
3 Lawn and Leaf Bags
4 Lawn and Leaf Bags
5 Lawn and Leaf Bags
6 Lawn and Leaf Bags
7 Lawn and Leaf Bags
8 Lawn and Leaf Bags
9 Lawn and Leaf Bags
10 Lawn and Leaf Bags
Lawn and Leaf Bags Removed by 3rd PARTY
Please use drop-down to select approximate amount of Lawn and Leaf Bags of vegetation removed by
3rd PARTY
.
1 Lawn and Leaf Bag
2 Lawn and Leaf Bags
3 Lawn and Leaf Bags
4 Lawn and Leaf Bags
5 Lawn and Leaf Bags
6 Lawn and Leaf Bags
7 Lawn and Leaf Bags
8 Lawn and Leaf Bags
9 Lawn and Leaf Bags
10 Lawn and Leaf Bags
Yard Waste Bins Removed by RESIDENT
Please use drop-down to select approximate amount of Yard Waste Bins of vegetation removed by RESIDENT.
1 Yard Waste Bin
2 Yard Waste Bins
3 Yard Waste Bins
4 Yard Waste Bins
Yard Waste Bins Removed by 3rd PARTY
Please use drop down to select approximate amount of Yard Waste Bins of vegetation removed by
3rd PARTY
.
1 Yard Waste Bin
2 Yard Waste Bins
3 Yard Waste Bins
4 Yard Waste Bins
Pickup Trucks Removed by RESIDENT
Please use drop-down to select approximate amount of Pickup Trucks of vegetation removed by
RESIDENT
.
1 Pickup Truck
2 Pickup Trucks
3 Pickup Trucks
4 Pickup Trucks
Pickup Trucks Removed by 3rd PARTY
Please use drop-down to select approximate amount of Pickup Trucks of vegetation removed by
3rd PARTY
.
1 Pickup Truck
2 Pickup Trucks
3 Pickup Trucks
4 Pickup Trucks
Dump Trucks Removed by RESIDENT
Please use drop-down to select approximate amount of Dump Trucks of vegetation removed by
RESIDENT
.
1 Dump Truck
2 Dump Trucks
3 Dump Trucks
Dump Trucks Removed by 3rd PARTY
Please use drop-down to select approximate amount of Dump Trucks of vegetation removed by
3rd PARTY
.
1 Dump Truck
2 Dump Trucks
3 Dump Trucks
Roll Off Dumpsters/Containers Removed by RESIDENT
Please use drop-down to select approximate amount of Roll Off Dumpsters/Containers of vegetation removed by
RESIDENT
.
1 Roll Off Dumpster/Container
2 Roll Off Dumpster/Containers
3 Roll Off Dumpster/Containers
Roll Off Dumpsters/Containers Removed by 3rd PARTY
Please use drop-down to select approximate amount of Roll Off Dumpsters/Containers of vegetation removed by
3rd PARTY
.
1 Roll Off Dumpster/Container
2 Roll Off Dumpster/Containers
3 Roll Off Dumpster/Containers
Please enter HOME ASSESSMENT HOURS completed
(Required)
Please use drop down to enter hours completed. If you completed more than the allotted hours, please resubmit another form.
1 Hour
2 Hours
3 Hours
4 Hours
5 Hours
6 Hours
7 Hours
8 Hours
9 Hours
10 Hours
Please enter COMMUNITY TEAM LEADER HOURS completed
(Required)
Please use drop down to enter hours completed. If you completed more than the allotted hours, please resubmit another form.
1 Hour
2 Hours
3 Hours
4 Hours
5 Hours
6 Hours
7 Hours
8 Hours
9 Hours
10 Hours
Please enter COMMUNITY EVENTS HOURS completed
(Required)
Please use drop down to enter hours completed. If you completed more than the allotted hours, please resubmit another form.
1 Hour
2 Hours
3 Hours
4 Hours
5 Hours
6 Hours
7 Hours
8 Hours
9 Hours
10 Hours
Please enter COMMUNICATIONS HOURS completed
(Required)
Please use drop down to enter hours completed. If you completed more than the allotted hours, please resubmit another form.
1 Hour
2 Hours
3 Hours
4 Hours
5 Hours
6 Hours
7 Hours
8 Hours
9 Hours
10 Hours
Please enter FUNDRAISER HOURS completed
(Required)
Please use drop down to enter hours completed. If you completed more than the allotted hours, please resubmit another form.
1 Hour
2 Hours
3 Hours
4 Hours
5 Hours
6 Hours
7 Hours
8 Hours
9 Hours
10 Hours
Please enter IT ASSISTANT HOURS completed
(Required)
Please use drop down to enter hours completed. If you completed more than the allotted hours, please resubmit another form.
1 Hour
2 Hours
3 Hours
4 Hours
5 Hours
6 Hours
7 Hours
8 Hours
9 Hours
10 Hours
Please enter BOARD MEMBER HOURS completed
(Required)
Please use drop down to enter hours completed. If you completed more than the allotted hours, please resubmit another form.
1 Hour
2 Hours
3 Hours
4 Hours
5 Hours
6 Hours
7 Hours
8 Hours
9 Hours
10 Hours
11 Hours
12 Hours
13 Hours
14 Hours
15 Hours
16 Hours
17 Hours
18 Hours
19 Hours
20 Hours
Please enter HOA/COMMUNITY HOURS completed
(Required)
Please use drop down to enter hours completed. If you completed more than the allotted hours, please resubmit another form.
5 Hour
10 Hours
15 Hours
20 Hours
25 Hours
30 Hours
35 Hours
40 Hours
45 Hours
50 Hours
Please enter HOA/COMMUNITY MONEY PAID to 3rd parties
(Required)
If you paid someone else to complete recommended HOA/COMMUNITY work on your behalf to harden your community against wildfire, please enter the amount paid.
Did a 3rd PARTY remove vegetation for the HOA?
(Required)
The amount of any vegetation removed for the HOA is required for Firewise recognition.
Yes
No
Type of 3rd PARTY for HOA Clearing Container Used
Please select from the five sizes of containers below, and use the dropdown to select the amount of containers used.
Lawn and Leaf Bag
Yard Waste Bin
Pickup Truck
Dump Truck
Roll Off Dumpster/Container
Lawn and Leaf Bags Removed by 3rd PARTY for HOA
Please use drop-down to select approximate amount of Lawn and Leaf Bags of vegetation removed by
3rd PARTY
.
1 Lawn and Leaf Bag
2 Lawn and Leaf Bags
3 Lawn and Leaf Bags
4 Lawn and Leaf Bags
5 Lawn and Leaf Bags
6 Lawn and Leaf Bags
7 Lawn and Leaf Bags
8 Lawn and Leaf Bags
9 Lawn and Leaf Bags
10 Lawn and Leaf Bags
Yard Waste Bins Removed by 3rd PARTY for HOA
Please use drop down to select approximate amount of Yard Waste Bins of vegetation removed by
3rd PARTY
.
1 Yard Waste Bin
2 Yard Waste Bins
3 Yard Waste Bins
4 Yard Waste Bins
Pickup Trucks Removed by 3rd PARTY for HOA
Please use drop-down to select approximate amount of Pickup Trucks of vegetation removed by
3rd PARTY
.
1 Pickup Truck
2 Pickup Trucks
3 Pickup Trucks
4 Pickup Trucks
Dump Trucks Removed by 3rd PARTY for HOA
Please use drop-down to select approximate amount of Dump Trucks of vegetation removed by
3rd PARTY
.
1 Dump Truck
2 Dump Trucks
3 Dump Trucks
Roll Off Dumpsters/Containers Removed by 3rd PARTY for HOA
Please use drop-down to select approximate amount of Roll Off Dumpsters/Containers of vegetation removed by
3rd PARTY
.
1 Roll Off Dumpster/Container
2 Roll Off Dumpster/Containers
3 Roll Off Dumpster/Containers
Please enter WATCH VIDEO HOURS completed
(Required)
Please use drop down to enter hours completed. If you completed more than the allotted hours, please resubmit another form.
0.5 Hours
1 Hours
1.5 Hours
2 Hours
2.5 Hours
3 Hours
3.5 Hours
4 Hours
4.5 Hours
5 Hours
Please enter READ DOCUMENTS HOURS completed
(Required)
Please use drop down to enter hours completed. If you completed more than the allotted hours, please resubmit another form.
0.5 Hours
1 Hours
1.5 Hours
2 Hours
2.5 Hours
3 Hours
3.5 Hours
4 Hours
4.5 Hours
5 Hours
Please enter OTHER HOURS completed
(Required)
Please use drop down to enter hours completed. If you completed more than the allotted hours, please resubmit another form.
0.5 Hours
1 Hours
1.5 Hours
2 Hours
2.5 Hours
3 Hours
3.5 Hours
4 Hours
4.5 Hours
5 Hours
Would you like to receive our newsletter?
We email out an informative monthly newsletter of important information about keeping your property safe from wildfires.
Yes
No
Notes
Please add any details about your recorded volunteer hours.
Hidden
Combined Cubic Yards Gravity
Combined Cubic Yards Gravity
Email
This field is for validation purposes and should be left unchanged.
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