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Client Information and Release Form - Motorola Solutions Mobile App

This form from the American Red Cross helps with relaying information between a disaster victim and his or her family after a disaster has occurred. The form records the victim's current address after the disaster, his or her address before the disaster and contact information for the victim. The form also allows the victim to give his or her consent to the holder of the form to give this information to family members and, most importantly, to give family members notification of the victim's current status. This app works on a variety of Motorola Soloutions devices, including the ES400 and ET1.

  • Lendlease
  • The Cooperative
  • PG&E
  • Red Bull
  • Mirvac

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Take a peek inside the Client Information and Release Form - Motorola Solutions Mobile App

Included Features

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Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico statictext

    Client Information

  • Ico textbox

    Name

  • Ico date

    Date

  • Ico textbox

    Pre-Disaster Address

  • Ico textbox

    Post-Disaster Address

  • Ico textbox

    Pre-Disaster Phone

  • Ico textbox

    Post-Disaster Phone

  • Ico textbox

    Name

  • Ico textbox

    Relationship to you

  • Ico textbox

    Address

  • Ico textbox

    Phone

  • Ico textbox

    E-mail

  • Ico textbox

    Your Short Message

  • Ico dropdown

    I authorize the American Red Cross to contact the designated family member to relay the previous ...

  • Ico signature

    Signature of Client

  • Ico textbox

    Printed Name of Client

  • Ico date

    Date

  • Ico textbox

    Name of Red Cross Worker

  • Ico textbox

    Function

  • ...and More!

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