La Salle Fire Assistance Form
If you and your family have been affected by the wildfires OR are able to assist those who have been affected, please fill out the form below.
PARENT/EMPLOYEE/ALUMNI FULL NAME 1
*
PARENT/GUARDIAN FULL NAME 2
STUDENT FULL NAME(S)
*
If Employee or Alumni, please write N/A
STUDENT GRADE(S)
*
9
10
11
12
N/A - Alumni
N/A - Employee
PRIMARY PHONE NUMBER
*
Please enter a valid phone number.
SECONDARY PHONE NUMBER
Please enter a valid phone number.
EMAIL ADDRESS
*
example@example.com
HOME ADDRESS
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Has your home and/or family been impacted by the fire?
*
Yes
No
If yes, how have you been impacted?
Do you require any assistance related to the fires?
If your family was not directly impacted by the fires and can provide community assistance to those who have been impacted, please let us know how you are able to assist below:
If you would like to be added to a support and/or volunteer list, please check the box below:
Yes, I would like to opt in to a support and/or volunteer list
Submit
Should be Empty: