SFC SafetyNet Registration Form : Sherwood Firewise

* Required fields

First Name *

Last Name *

Cell Phone *

Land Line

Main SafetyNet notification – check one or more *

Text
Landline
Cell
Email

Sherwood Corridor Address – House Number *

Street *

Street Type (Ave., St., Rd…) *

City *

State *

Zip *

Mailing Address (if different) – House Number

Street Name

Street Type (Ave., St., Rd…)

City

State

Zip

Household Members (may include pets). Each adult who wishes to be notified must fill out a form.

Special Circumstances: Special situations on property; locked gate, poor reception, etc.; language, mobility, perceptual, cognitive, caring for others, etc.

Do you have a 2nd dwelling unit on the property

Donation (optional)

Stripe is a secure method of paying by credit card.
To read about the application click here.

Stripe Credit Card

Card

Name on Card

By clicking on ‘Submit and Agree’ I indicate that I have read and agree to Sherwood Firewise SafetyNet Terms of Service and wish to join SafetyNet. I understand that SafetyNet is a volunteer organization & assumes no responsibility for notification but will do its best to notify me as early as possible of fire incidents in the area.

SafetyNet Terms of Service

If you would rather download and mail your application click below. Payment by check made payable to Sherwood Firewise. Mail to: 75 North Main Street #234, Willits, CA 95490

SFC-safetyNet-TERMS19.07.13 Download