Brookshire, TX · Waller County
Disaster Senior Citizen Welfare Check Registration Form
Brookshire senior residents complete this registration form to request disaster-related wellness checks and provide information that can help the city check on their safety and health.
What this form is
This form registers senior residents for City of Brookshire wellness checks before and/or after a disaster. It asks for resident and emergency contact details, health and wellness information, and consent for city personnel to conduct checks and contact the emergency contact if needed. The document does not state a deadline or list required attachments.
Who needs it
Senior Brookshire residents who want the city to conduct wellness checks before or after a disaster should complete this registration form.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details. The form lists Community Relations Specialists as a contact.
About notarization
This form is signed and dated without a notary; it lists no notarized or sworn attachment, so the signer just signs and dates it.
How to submit this form
- 1
Download the Form
Download the City of Brookshire Disaster Senior Citizen Welfare Check Registration Form.
- 2
Complete the Form
Fill in the resident, emergency contact, and health and wellness information requested.
- 3
Review and Sign
Read the consent statement, then print your name, sign, and date the form.
- 4
Submit to the City
Submit the form to the city department named on it; check the city website for current contact details.
Frequently asked questions
- What is the Disaster Senior Citizen Welfare Check Registration Form?
- It registers senior residents for City of Brookshire wellness checks before and/or after a disaster and collects resident, emergency contact, and health information.
- Who should complete this Brookshire form?
- Senior residents who want the city to conduct disaster-related wellness checks should provide their information and consent using this registration form.
- Do I need a notary for the Disaster Senior Citizen Welfare Check Registration Form?
- No. The form has a signature and date line but no notary block or notarized attachment; the signer just signs and dates it.
- How do I submit the Disaster Senior Citizen Welfare Check Registration Form?
- Submit it to the city department named on the form and check the city website for current contact details. The form lists Community Relations Specialists as a contact.
Need something notarized?
This Disaster Senior Citizen Welfare Check Registration Form doesn’t need a notary — but Texas residents can notarize other documents online with a commissioned online notary.