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Resident Information Form
Your name, phone and email
Reason for Entry
(Change of ownership (include previous owner name), gathered more data, etc)
Prior Owner
If the previous resident has moved out of the Nehalem Valley area, please enter the name. If you know they are still in the area, please let us know which town. Each resident must be listed on a separate form.
Contact Information
Name - Use a separate form for each person
First Name
Last Name
Nickname
Name you would use in a "Dear Whatsyourname" email
Email
Verify Email
Phone
Cell phone
Nehalem Bay area physical address
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Mailing Address
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Cluster Name
Classic Ridge
Highlanders
Lower Neahkahnie
Manzanita Beach
Mid Neahkahnie
Nehalem
North Reed Road
Northfork
Pine Ridge
Ridge Rats
Southside
Sunset Meadow
Wheeler
The Lanes
Bayside Gardens
The Cottages
Cluster Section
If your Cluster is divided into neighborhoods/blocks, select here to represent this person's Section. This will allow you to send custom reports to each captain in your Cluster.
select one
Section 1
Section 2
Section 3
Section 4
Section 5
Section 6
Section 7
Section 8
Section 9
Section 10
Zone (Number 1-9)
Inundation Zone
Yes
No
Status
FT= full time; PT=Part time, LTR= long term renter; STR=short term rental house; LTO= long term rental owner; MGMT CO= a company that manages STR's (sunset, vacasa, etc.); TLO=empty lot owner
FT
PT
LTR
STR
LTO
MGMT CO
TLO
unknown
Contact Type
P= single resident or resident with more classes (can be arbitrary) S= spouse or other resident
Primary
Secondary
Family Plan
Has a contact out of the area, has a plan to reach each family member
Yes
No
Evacuation Route
Knows how and where to go in an emergency
Yes
No
Go-Bag
Yes
No
Camping at Home Supplies
Has food and camping equipment to last at least several weeks.
Yes
No
Chainsaw
Y/N for Primary, H for Secondary if Primary is Y, N if Primary is N
Yes
No
H
Generator
Y/N for Primary, H for Secondary if Primary is Y, N if Primary is N
Yes
No
H
Propane tank
Y/N for Primary. H for Secondary if Primary is Yes. No if Primary is No
Yes
No
H
Pets?
Yes if they have Pets (you can enter details in the Notes field if desired).
Yes
No
Notes
Special Needs, Name of Cat, Emergency Contact, Children at home, etc
Relationships
Is this person related to another person? (Spouse, partner, Rental unit owner, housemate, etc.) Please list the other person and the relationship.
