This Safe Room Registration form is provided as a way for residents to inform public safety personnel where their safe room or shelter is located. This information will be listed in a database that will be utilized in the event of a disaster to help determine where residents may be trapped. The information is kept confidential and will not be shared with individuals, companies, or other agencies.

It is very important that you enter the information correctly. Please review the information before you press the submit button. ALL BLANKS SHOULD BE COMPLETED. If you have any problems submitting the form, please contact Emergency Management at 405-222-6035.

This database was created for City of Chickasha residents only. If you address is located outside the city limits, your information will not be saved. If you live outside the city limits contact Grady County Emergency Management at 405-222-2359.

First Name*

Last Name*

House Number*

Street Name*

City

State

Zip

Email Address

Phone Number

Average number of people that will use the shelter

Location of the shelter on the property (be specific)

Shelter Type

Under Ground Above Ground

Material

Concrete Steel

Additional Comments