1. If you are experiencing an emergency, do not use this form. Please call 911.
2. Adults over the age 18 must complete this form themselves. You cannot complete this form for another adult.
3. If you are under the age of 18, please call us for assistance at 800-968-8143.
4. Internet communication is not checked on evenings, weekends, federal holidays, or states of an emergency requiring business closure. For immediate assistance, please call 800-968-8143.