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Disaster Evacuation Plan

1.Contact Information(Required.)

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

2.Evacuation Plan: Designated Location (ex. hotel or relatives' name)(Required.)

Name (family member, relative, hotel, etc.)

Relationship (if applicable)

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

3.Further Explanation (if necessary)

4.Any additional contact information (other than listed above)

Name

Relationship

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

In the case of an evacuation, you are to contact your case manager and probation officer with you location and contact information.

If you possess ETOH, SCRAM, or HIP equipment, you must take the equipment with you and keep it powered until you are able to return home.

Once it is safe to return home, you will be expected to return within 24-48 hours.

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