RegWithLaw
(
type: esriFieldTypeString, alias: Are you required by law to register with a state or local government agency?, length: 255
, Coded Values:
[Yes: Yes]
, [No: No]
)
Veteran
(
type: esriFieldTypeString, alias: Are you a veteran or part of active military?, length: 255
, Coded Values:
[Yes: Yes]
, [No: No]
)
InformationWaiver
(
type: esriFieldTypeString, alias: I agree to have my information shared with other agencies providing disaster relief services. (*this is optional), length: 255
, Coded Values:
[Yes: Yes]
, [No: No]
)
ParentPhone1
(
type: esriFieldTypeString, alias: First Parent or Guarding Phone #:, length: 255
)
NumberOfFamMembers
(
type: esriFieldTypeInteger, alias: How many people in your family/household will be sheltering during the storm?
)
SpecialNeeds
(
type: esriFieldTypeString, alias: Do you have special medical needs we should know about?, length: 255
, Coded Values:
[Yes: Yes]
, [No: No]
)
SpecialNeedsComments
(
type: esriFieldTypeString, alias: Provide details about your special medical needs:, length: 255
)
SpecialNeedsAssistance
(
type: esriFieldTypeString, alias: Will you require assistance from shelter staff to address your special medical needs?, length: 255
, Coded Values:
[Yes: Yes]
, [No: No]
)
MinorParentName2
(
type: esriFieldTypeString, alias: Name of Second Parent or Guardian:, length: 255
)
ParentPhone2
(
type: esriFieldTypeString, alias: Second Parent or Guarding Phone #:, length: 255
)
MinorsWithYou
(
type: esriFieldTypeString, alias: Are any minors with you in the shelter?, length: 255
, Coded Values:
[Yes: Yes]
, [No: No]
)
MinorsCount
(
type: esriFieldTypeInteger, alias: How many minors are with you in the shelter?
)
SpecialNeedsAssistanceComments
(
type: esriFieldTypeString, alias: Provide details about the type of assistance you will need:, length: 255
)
Pets
(
type: esriFieldTypeString, alias: Are you entering the shelter with any pets?, length: 255
, Coded Values:
[Yes: Yes]
, [No: No]
)
PetsCount
(
type: esriFieldTypeInteger, alias: How many pets do you have with you?
)
PetsDetails
(
type: esriFieldTypeString, alias: Please describe your pets. Include names, physical descriptions, kennel/cage needs, and if they are service animals., length: 255
)
MinorDetails
(
type: esriFieldTypeString, alias: Please provide the names and ages of the minors accompaning you:, length: 255
)
PrimaryLanguage
(
type: esriFieldTypeString, alias: What is your primary language?, length: 255
, Coded Values:
[Eng: English]
, [Span: Spanish]
, [Fr: French]
, ...6 more...
)
ExpectedDeparture
(
type: esriFieldTypeString, alias: How long do you expect to stay at the shelter?, length: 255
)
FoodProvided
(
type: esriFieldTypeString, alias: Will you need food and drink provided by the shelter?, length: 255
, Coded Values:
[Yes: Yes]
, [No: No]
)
ExpectToCheckOut
(
type: esriFieldTypeString, alias: Do you expect to have to leave the shelter at anytime during the storm event before your final departure?, length: 255
, Coded Values:
[Yes: Yes]
, [No: No]
)
ExpectToCheckOutDetails
(
type: esriFieldTypeString, alias: Please describe potential reasons to need to leave the shelter during the storm event:, length: 255
)
CurrentDisposition
(
type: esriFieldTypeString, alias: What is your current mood/disposition?, length: 255
, Coded Values:
[Happy: Happy]
, [Neutral: Neutral]
, [Calm: Calm]
, ...5 more...
)
OnSpecialNeedsReg
(
type: esriFieldTypeString, alias: Are you an Ascension Parish resident and currently on our Special Needs Registry?, length: 255
, Coded Values:
[Yes: Yes]
, [No: No]
)