STEAR Registration Form

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State of Texas Emergency Assistance Registry

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If you are filling this out on behalf of someone else, answer these questions from their perspective. To complete a STEAR registration, some basic information is required. This information is marked with an asterisk (). You may choose to answer all or only some of the optional questions in the Personal Info and Contact Info. Most of the questions in the Assistance, Conditions & Equipment are required. Answers to these questions help Local Data Custodians coordinate the needs of individuals with first repsonders.

Personal Info - Basic Registrant Information

Registering for STEAR doesn't guarantee you assistance in an emergency. By registering in STEAR you are consenting to sharing your information with first responders and other state agencies during a disaster.

Name & Login

Please select a Facility to register individuals if they live in a facility.

1. What is your primary language? If you speak more than one language, choose the best language that you would use for emergency communications. For persons who cannot communicate, please choose non-verbal.

2. Do you need a sign language interpreter? Yes No

3a. What is your first name?

3b. What is your last name?

Physical Street Address

4a. What is your street address?

4b. Do you have an apartment number? If so, put it here.

4c. What is your Zip Code?

4d. If you know the +4 part of your Zip Code, put it here.

4e. What is your City?

5. What is the County you live in?

Please map the address to give more accurate information to the first reponders (it gets the latitude and longitude).
Enter the Address, Zip Code, City, and County first, and if the boxes below are blank, click the "Map It" button and then press "OK".

Is mailing address same as above? Please check the box Otherwise, answer below.

Mailing Street Address

6a. What is your mailing address street & number?

6b. Do you have an apartment number? If so, put it here

6c. What is your mailing Zip Code?

6d. If known, what is your mailing address +4 Zip code?

6e. What is your mailing address City?

7a. What is your email address? (if you have one)

7b. Confirm email address:

8a. What is the best phone number to reach you at?

8b. Is the best phone number a Cell Phone? (if so, pick one)
Yes (US Cell Phone) OR Yes (International Cell Phone)

9. Do you have a second number to reach you at?

10. If you are a minor (younger than 18) or if the person you are registering is a minor, please enter their age in years. Enter 0 for children less than 1 year old. Leave blank for adults.

Emergency Contact Information

In these questions, emergencies are defined as hazards to public health and safety, such as hurricanes, tornadoes, terrorist attacks, chemical accidents, and other disasters that may cause death, injury, or damage, which could require evacuation and sheltering of the public.

11a. What is your emergency contact person's first name?

11b. What is your emergency contact person's last name?

11c. What is this person's relationship to you?

11d. What is your emergency contact's telephone number? Remember, this needs to be the best way to contact this person in case of an emergency.

Summary of Information

Click here when form is filled and if you want a summary of the form. If you update more after, click here again to refresh this Summary section.

Review Form

# = Question Number(s)

Personal Info - Basic Registrant Information \| Edit
1 Primary Language:	2 Sign Language?
3a/3b Registrant Name:
4a/4b/4c/4d/4e/5 Physical Address:
6a/6b/6c/6d/6e Mailing Address:
7 Email Address:
8a Phone No:	8b Cell Phone?: US Cell: International Cell:
8c Cell Phone Carrier:	9 Alt. Phone No:
10 Age, if minor:
Emergency Contact Information \| Edit
11a/11b Emergency Contact Name:
11c Emergency Contact Relationship:	11d Emergency Contact Phone:
Assistance, Conditions & Equipment - During Emergency, Including Evacuation\| Edit
12 Service Animal Evacuate with You:
13a Caregiver Present:	13b Caregiver Evacuate with You?
14 People Accompanying:
15a Evacuate with Pets?:
15b Total Number of Pets Evacuating:	15c Pet Carriers for all Pets?
16a Disability/Medical Need that Prevents from Understanding Instructions/Warnings?:
16b Vision Assistance:	16c Communication Notes:
17 Trans Assistance to Evac:	18 Trans Assistance get to a Local Assembly Point or Shelter:
19 Moving Assistance to Evac Your Home:
20 Identify as a medically fragile individual?
21 Alzheimer's or other related disorders?
22 Debilitating chronic illness?
23 Receive dialysis services?
24 Medical condition that requires 24-hour supervision from a skilled nurse?
25a Powered Med Device:	25b Hours of Power:
26 Evac Addt'l Functional Help:
27 Frequent Med Treatment From a Nurse or Doctor:
28a Help Carrying Out Activities of Daily Living:	28b Daily Needs Help From a Service Provider:
28c Portable Oxygen:	29 Cannot Sit Upright:
30 More than 350 lbs:
31a Durable Med Device:	31b Motorized or Custom Wheelchair?:
32 Other Medical Equipment:	33 Storm Cellar or Safe Room:
34 Additional Comments or Notes:

State of Texas Emergency Assistance Registry

Already have an account?

Note!

Record already exists in STEAR

Personal Info - Basic Registrant Information

Registering for STEAR doesn't guarantee you assistance in an emergency. By registering in STEAR you are consenting to sharing your information with first responders and other state agencies during a disaster.

Name & Login

Physical Street Address

Is mailing address same as above? Please check the box Otherwise, answer below.

Mailing Street Address

Emergency Contact Information

Emergency Contact Information

Assistance, Conditions & Equipment - During Emergency, Including Evacuation

Caregivers and Animals

Emergency Warnings and Instructions

Transportation Assistance

Medically Fragile

Functional Needs

Summary of Information

Click here when form is filled and if you want a summary of the form. If you update more after, click here again to refresh this Summary section.

Review Form

Personal Info - Basic Registrant Information | Edit

Emergency Contact Information | Edit

Assistance, Conditions & Equipment - During Emergency, Including Evacuation| Edit

State of Texas Emergency Assistance Registry

Already have an account?

Note!

Record already exists in STEAR

Personal Info - Basic Registrant Information

**Registering for STEAR doesn't guarantee you assistance in an emergency. By registering in STEAR you are consenting to sharing your information with first responders and other state agencies during a disaster.**

Name & Login

Physical Street Address

Is mailing address same as above? Please check the box Otherwise, answer below.

Mailing Street Address

Emergency Contact Information

Emergency Contact Information

Assistance, Conditions & Equipment - During Emergency, Including Evacuation

Caregivers and Animals

Emergency Warnings and Instructions

Transportation Assistance

Medically Fragile

Functional Needs

Summary of Information Click here when form is filled and if you want a summary of the form. If you update more after, click here again to refresh this Summary section.

Review Form Print

Personal Info - Basic Registrant Information | Edit

Emergency Contact Information | Edit

Assistance, Conditions & Equipment - During Emergency, Including Evacuation| Edit

Registering for STEAR doesn't guarantee you assistance in an emergency. By registering in STEAR you are consenting to sharing your information with first responders and other state agencies during a disaster.

Summary of Information

Click here when form is filled and if you want a summary of the form. If you update more after, click here again to refresh this Summary section.

Review Form