This Safe Room Registration Form is to provide the Jackson County Emergency Management Agency information needed in order to locate your saferoom in the event of a disaster.

The information is kept confidential and will not be shared with individuals, companies or other agencies.

Please review the information before you press the submit button.

(IF YOU HAVE PROBLEMS SUBMITTING THE FORM, PLEASE CONTACT THE JACKSON COUNTY EMERGENCY MANAGEMENT OFFICE AT (256) 574-9344

Please fill out the following information and press the SUBMIT button.
Thank you for providing this possible life saving information.

Name:*

Shelter Address: (NO P.O. Box Numbers)*

City:*

State:

Alabama

Zip Code:*

Phone Number:(xxx-xxx-xxxx)*

E-mail Address:

Year saferoom was built:
*

Location and description of the shelter on the property (Be specific):
(Back yard, garage, bedroom, square footage, under storage building, year built, etc.)*

Please select each item that best describes your shelter.*

Inside a Building Outside all Buildings Concrete

Steel Under Ground Above Ground

Comments: (if you have the GPS coordinates please input them here)