COVID 19 Geary Oklahoma Database

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Names of those in your household *

Number of people in your household *

Home Address *

Phone number *

Age of those in your household? *

Do you want a Red and Green Status card? *

Yes

Are you or someone in the household on oxygen? *

Yes

Prefer not to say

Are you or someone in the household Diabetic? *

Yes

Prefer not to say

Do you have a Storm Shelter? *

Yes

Prefer not to say

Location of Shelter

Type of Shelter

Basement

Saferoom

Outdoor Cellar

Garage Shelter

Outside Safe Room

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Are you or someone in your household willing to volunteer to help others in the town?

Yes

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What ways could you or someone in your household help?

Comments and suggestions for the City of Geary COVID-19 Taskforce

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