Help people find the help they need, fast.
When someone needs disaster relief, finding a location shouldn’t be another obstacle. This template leads with a map of active relief sites — shelters, food distribution points, supply centers, medical triage locations — so people can orient themselves before they fill out a single field.
The intake form that follows collects the information your teams need to prepare: household size, type of assistance needed, and contact details. The result is a form that works for the people using it and the people running the operation.
Designed for the Moments That Matter Most
In an emergency, a dropdown list of addresses is the last thing someone should have to navigate. This template puts the map first — front and center, before any form fields — so that finding a location is the very first thing a visitor can do.
Relief coordinators benefit too. When individuals select which site they’re heading to as part of their intake, you get a real-time picture of expected arrivals at each location. Combined with the household size and assistance type fields, your teams can anticipate needs and allocate resources before people arrive.
Each pin on the map can carry a name and description — hours, available services, capacity notes — so the map itself becomes a communication tool, not just a visual.
Form Fields
- Map — placed at the top of the form, displays all active relief sites
- Name — individual or household contact name
- Email — for follow-up communications when available
- Phone — primary contact number
- Number of People in the Household — helps relief sites prepare appropriate resources
- Type of Assistance Needed — checkboxes covering food, shelter, medical, clothing
- Comment or Message — open field for additional context or special needs
Notes on Setup
Placing the map at the very top of this form is a deliberate choice — people in crisis need to locate help before anything else. Use high-contrast marker colors so pins stand out immediately, and keep pin descriptions current as site availability changes. Entries will show the selected location alongside household data, making it easier to manage intake across multiple sites from a single dashboard.
Use Cases
- Emergency management agencies coordinating multi-site disaster response
- Nonprofits managing shelter and supply distribution after natural disasters
- Community organizations running food and water distribution
- Healthcare networks coordinating emergency medical intake
- Municipal or county government emergency services
When every minute counts, the last thing you need is a form that gets in the way. Sign up for WPForms Pro to access this template, thousands of others, and all the features you need to get a relief intake form live quickly — no technical experience needed.
