BE CERTAIN TO ADD THE PERSON YOU WISH TO RECEIVE THIS TO YOUR RECIPIENTS BOX BEFORE SELECTING THIS TEMPLATE. PLEASE NOTE THAT THIS DOCUMENT IS FOR INFORMATIONAL PURPOSES ONLY AND HAS NO LEGAL AUTHORITY. HOWEVER IT WILL PROVIDE YOUR FAMILY WITH THE INFORMATION THEY NEED IN AN EMERGENCY.

Make sure your family has a plan in case of an emergency. Before an emergency happens, decide how you will get in contact with each other, where you will go and what you will do in an emergency. Keep a copy of this plan in your emergency supply kit or another safe place where you can access it in the event of a disaster.

REMEMBER THIS DATA IS ENCRYPTED/LOCKED BEFORE IT LEAVES YOUR COMPUTER THERE IS ABSOLUTELY NO WAY POSSIBLE TO RETRIEVE THIS INFORMATON WITHOUT YOUR OR [[RECIPIENT_USERNAME]]'S PASSPHRASE PERIOD.

A community working together during an emergency makes sense.

DELETE THE ABOVE LINES BEFORE SAVING THIS DOCUMENT.

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IMPORTANT EMERGENCY INFORMATION

PRINT AND FOLLOW ACCORDING TO PLAN

From: [[SENDER_USERNAME]]

As of: [[TODAY_DATE]]

Dear [[RECIPIENT_USERNAME]],

This is an AUTHENTICATED document if this message has been sent to you it is because I have activated the VitalLock Personal Emergency Broadcast System. THIS IS NOT A TEST.

Out-of-Town Contact Name:_____________ Telephone Number:_____________ Email:_____________

Neighborhood Meeting Place:_____________ Telephone Number:_____________ Regional Meeting Place:_____________ Telephone Number:_____________ Evacuation Location:_____________ Telephone Number:_____________

Fill out the following information for each family member and keep it up to date. Name: [[SENDER_USERNAME]] SSN:_____________ DOB:_____________ Medical Info:_____________

Name: [[RECIPIENT_USERNAME]] SSN:_____________ DOB:_____________ Medical Info:_____________

Name:_____________ SSN:_____________ DOB:_____________ Medical Info:_____________

Name:_____________ SSN:_____________ DOB:_____________ Medical Info:_____________

Name:_____________ SSN:_____________ DOB:_____________ Medical Info:_____________

Name:_____________ SSN:_____________ DOB:_____________ Medical Info:_____________

Write down where your family spends the most time: work, school andother places you frequent. Schools, daycare providers, workplaces and apartment buildings should all have site-specific emergency plans that you and your family need to know about.

Work Location One Address:_____________ Phone Number:_____________ Evacuation Location:_____________ Work Location Two Address:_____________ Phone Number:_____________ Evacuation Location:_____________ Work Location Three Address:_____________ PhoneNumber:_____________ Evacuation Location:_____________ Other place you frequent Address:_____________ Phone Number:_____________ Evacuation Location:_____________ School Location One Address:_____________ Phone Number:_____________ Evacuation Location:_____________ School Location Two Address:_____________ Phone Number:_____________ Evacuation Location:_____________ School Location Three Address:_____________ Phone Number:_____________ Evacuation Location:_____________ Other place you frequent Address:_____________ Phone Number:_____________ Evacuation Location:_____________ Important Information Names Telephone Numbers Policy Numbers Doctor(s):_____________ Other:_____________ Pharmacist:_____________ Medical Insurance:_____________ Homeowners/Rental Insurance:_____________ Veterinarian/Kennel (forpets):_____________