Pop Up Cooling Station Host Interest Form

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Pop Up Cooling Station Host Interest Form - Summer 2023

Thank you for your interest in hosting a pop-up cooling station at your home or business! Please fill out the information below to let us know who you are and to give a sense of your space.

We will do our best to respond to you quickly but coordinating collaborative community efforts can sometimes slow down our response time. Please note that submitting this form does not guarantee Alchemist CDC will be able to support a Cooling Station on your property, as we have to do our best to allocate limited resources and need to evaluate each space for likely impact and be sure not to duplicate services in the same area.

Email *

Name *

Address of Proposed Cooling Stations Site *

We won't publish your exact address in the list of locations but will provide the nearest cross street.

Phone number

Please check any items that you already have: *

Pop up tent (or well-shaded area with trees)

Misting system/mister

Ice Chest

Sign making materials

Hose that can reach from your spigot to the proposed cooling station area

I don't have any of these yet

Required

Please check all statements that are true about the proposed cooling station location: *

I am authorized to volunteer this location to host a pop up center.

I am willing to host this pop up center again in future heat waves.

If I decide not to host a cooling station again in the future, I will contact Alchemist CDC to let them know and will return any equipment they provided for a cooling station so they can be used elsewhere.

My proposed site has access to a spigot that can run the misters.

My proposed site is likely to be seen and used by people who need it. (We are asking this question because some places are tucked away from foot traffic, not near many vulnerable people, etc.)

I am already hosting a pop up cooling station but could use help stocking it with beverages and ice.

I am ok with Alchemist sharing the nearest intersection on a list of cooling stations to help people find it. (Alchemist will not share the exact address for a home)

Required

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