U.S. flag

An official website of the United States government

Dot gov

Official websites use .gov
A .gov website belongs to an official government organization in the United States.

Https

Secure .gov websites use HTTPS
A lock ( ) or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.

    world globe    

The information you provide is not saved, stored or shared by any government agency.

You may not be together when disaster strikes, so it’s important to know how you’ll reconnect if separated. Use this form to create a Family Emergency Communication Plan, which you can email as a PDF file once complete.

Household Information

 Order
Home #: Address:

Family Members

Enter information for each member of your family.

 Order
Name: Mobile #: Other # or social media: E-mail: Important medical or other information:

Emergency Plans

Enter information for schools, childcare, caregivers and workplaces.

 Order
Name: Address: Emergency/Hotline #: Website: Emergency Plan/Pick-Up:

Emergency Contacts

 Order
Name: Mobile: Home #: Email: Address:

Emergency Meeting Places

 Order
Location: Instructions:

Medical Information

 Order
Poison Control:

Order
Doctor Name: Doctor #:

Order
Pediatrician Name: Pediatrician #: Allergy information and prescriptions:

Order
Medical Insurance Name: Medical Insurance Policy #:

Order
Veterinarian Name: Veterinarian #:

Send Email

 Order
Enter an email address to send the generated PDF Report to:

Last Updated: 06/07/2026

Return to top