PLEASE COMPLETE ALL BLANKS ON THIS FORM TO THE BEST OF YOUR ABILITY. No Relief Assistance will be provided without completing this form either here online or by downloading our printable form from our page or by completing same in person at a one-on-one interview.
Alamo Resource Conservation & Development Area Inc.
Hurricane Harvey Relief Program Registration Form
All entries marked with an ** must be completed.
Full Name of Head of Household **
Original Street Address or PO Box **
Original City/State/Zip **
Original County of Residence **
Provide your complete current address below as follows: **
Name of Hotel, Apartment or Next of Kin
City, State, Zip
Press RESET to clear all Entries and start over.
Provide Local Contact: (Next of Kin) **
City, State, Zip
Cell Phone: (XXX) XXX-XXXX **
Please check preferred form of contact **
Please list AGE and FIRST NAME of each Adult and Child in your Family **
Do you want to allow photos and quotes from your family to be used in publications, web or social media? **
Please LIST your top five needs from 1 to 5 with one being your biggest need at this time. (examples: Food, clothing, gas, shoes, prepared foods, medical, diapers, Poise or depends, and more.**
Provide us with a note about your experiences during and after Hurricane Harvey. Please explain your needs also. Your note may be used on the web and in publications, if you have provided permission. **
By SUBMITTING THIS ONLINE FORM, you indicate that all information on this form is true and factual. You also agree to sign a Statement of Release of Liability and to provide us with a proper ID in the form of a drivers license or other form of picture ID when we meet for a one-on-one interview.
Double click here to add text.
Press SUBMIT to enter your REGISTRATION. All entries are final.
Upon Submission the form is automatically sent to firstname.lastname@example.org, Thank you for your Application.
Alamo RC&D Area Inc.
215 W. Bandera Rd. Suite 114-456
Boerne, Texas 78006
Serving Central Texas as an IRS Designated 501(c)(3) nonprofit organization. All donations are tax deductable as per current tax law.