Skip to Main Content
Loading
Loading
Government
Departments
Economic Development
Residents
How Do I...
Home
Form Center
Form Center
Search Forms:
Search Forms
Select a Category
All Categories
Boards and Committees
CivicPlus Test Category
Fire Department
Leisure Services
Mayor's Health & Fitness Challenge 2018 Registration Form
Neighborhood Improvement
Planning & Building
Police Department
Public Works
Report a Concern
Support Services
By
signing in or creating an account
, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.
Sand Bag Distribution Program for Persons with Special Needs
Sign in to Save Progress
This form has been modified since it was saved. Please review all fields before submitting.
If you are a resident of the City of Ormond Beach and are physically unable to fill a sandbag, or to unload a prefilled sandbag from your vehicle, you may submit this form to request that sandbags be delivered directly to your residence. Please provide accurate contact information to ensure your request is reviewed and arrangement for delivery can be made.
Date
*
Date
First Name
*
Last Name
*
Street Address
*
Suite / Apartment
City
*
State
*
Zip
*
Contact Phone Number
*
Email Address
*
Number of Requested Sandbags (maximum of 10)
*
Instructions:
Upon approval, Public Works will coordinate a one-time delivery of prefilled sandbags. The applicant is responsible for the placement of sand bags at his or her residence. If you have questions, please call the Public Works Department at 386-676-3220.
By submitting this form I certify that I am not physically capable of collecting or filling sandbags, or unloading a prefilled bag from a vehicle; and that I do not have someone living in my residence who can do so on my behalf.
Leave This Blank:
Receive an email copy of this form.
Email address
This field is not part of the form submission.
Submit
* indicates a required field
Airport
Bidding Opportunities
Boards & Committees
Brownfield Program
Budget Information
City Commission
Codes & Legislation
Economic Development
Election Information
Employment
Leisure Services
Mayor's Fitness Challenge
Itinerant Application
Newsletters/Updates
Ormond Crossings
Ormond Beach CRAs
ProjectDox ePlans
Road Closures
Sports Field Conditions
Transparency Reports
Arrow Left
Arrow Right
[]
Slideshow Left Arrow
Slideshow Right Arrow