Block Captain Interest Form

Sullivan's Gulch Block Captain Program Interest Form

Thank you for your interest in the Sullivan's Gulch Block Captain Program. Your answers to these questions will help us prepare for the kickoff meeting scheduled for September 27th, from 10am-12pm at 2607 NE Wasco St.

Name *
Email
Phone
Block/Address *

What is your address or nearest road intersection?
Are you interested in being a Block Captain?
What experience/skills/interests make you a good fit for the program?

I already know at least several of my neighbors

I have first aid, CPR, and/or Stop the Bleed training

I have emergency response training

I am good a planning and wrangling small events

I am comfortable with MESH radios

Check all that apply (not required to become a Block Captain)
What are you most interested in?

E.g., meeting/connecting with neighbors, emergency preparation, mutual aid, etc.
Are you able to attend Block Captain Kick Off meeting on September 27th, 10-12pm? *