Template Field Operations Guide



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Family/Friend Registration Form


__________________

Use this form if no electronic/database registration system is available Tracking Number

Disaster Victim Information
(For Multiple Victims of Same Family, Use Additional Forms and Cross Reference by Name)

Last Name First Name MI




Next of Kin Information

Has Next of Kin (NOK) arrived at the Family Assistance Center?  Yes  No  Unknown

NOK Last Name First Name

Relationship to Victim

Current Address

City State Zip

Phone numbers

Medications/Medical Needs?  Yes  No

If Yes, Indicate Needs

Physician’s Name Physician’s Phone #

Notes


Information regarding Next of Kin provided by:

Relationship to Next of Kin:

  1. Presenting Family Member/Friend Name

Last Name First Name MI

Relationship to Victim

Permanent Address

City State Zip

Home Phone Cell Phone

Photo Identification Verification (type/#/State/County)

Additional considerations (medical, interpretation)?  Yes  No

If yes, please indicate:

Notes:


Family/Friend Registration Form (continued)


__________________

Use this form if no electronic/database registration system is available Tracking Number

  1. Presenting Family Member/Friend Name

Last Name First Name MI

Relationship to Victim

Permanent Address

City State Zip

Home Phone Cell Phone

Photo Identification Verification (type/#/State/County)

Additional considerations (medical, interpretation)?  Yes  No

If yes, please indicate:

Notes:






  1. Presenting Family Member/Friend Name

Last Name First Name MI

Relationship to Victim

Permanent Address

City State Zip

Home Phone Cell Phone

Photo Identification Verification (type/#/State/County)

Additional considerations (medical, interpretation)?  Yes  No

It yes, please indicate:

Notes:







Family/Friend Registration Form (continued)


__________________

Use this form if no electronic/database registration system is available Tracking Number

  1. Presenting Family Member/Friend Name

Last Name First Name MI

Relationship to Victim

Permanent Address

City State Zip

Home Phone Cell Phone

Photo Identification Verification (type/#/State/County)

Additional considerations (medical, interpretation)?  Yes  No

If yes, please indicate:

Notes






  1. Presenting Family Member/Friend Name

Last Name First Name MI

Relationship to Victim

Permanent Address

City State Zip

Home Phone Cell Phone

Photo Identification Verification (type/#/State/County)

Additional considerations (medical, interpretation)?  Yes  No

If yes, please indicate:

Notes





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