2024 Emergency Registration

Hay River Evacuation Pre-Registration Form 2024

Household Evacuee Primary Contact Name:(Required)

First Last

Primary Evacuee Contact – Home Address(Required)

Street Name House #, Apartment # City Province

Contact Telephone:(Required)

Add additional family or household members?

First additional household member

First Last Age

Second additional household member

First Last Age

Third additional household member

First Last Age

Fourth additional household member

First Last Age

Fifth additional household member

First Last Age

Special Needs:(Required)

Pet(s)

Would you like to register your pet(s)?

First Pet's Name

First

First Pet Type

First Pet Status

Add additional pet?

Second Pet's Name

First

Second Pet Type

Second Pet Status

Evacuee Temporary Accomodation

Please choose one of the following 3 options:(Required)

I do not currently have temporary accommodations and I am interested in Town provided accommodations the Hay River Community Centre.

I have found accommodations and can provide the following contact information:

I am refusing temporary accommodations and will be staying at my residence.

Accommodation Location and Contact

Accommodation Contact Name

First Last

Accommodation Address

Street Name House #, Apartment # City Province

Accommodation Phone

In the scenario of a mass evacuation, would you require public transportation (ie bus) to the host community (ie. Yellowknife)?(Required)

Yes

No

To be completed by Registration Agent:

Click here if completed by an evacuation centre registration agent

Registration Agent Name:

First Last

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First Last
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2024 Emergency Registration

Hay River Evacuation Pre-Registration Form 2024

Pet(s)

Evacuee Temporary Accomodation

Accommodation Location and Contact

Resources

Town of Hay River

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