Cypress County - Property damage collection form

Property damage collection form

<form-template>
	<fields>
		<field type="header" subtype="h2" label="Background" class="header"></field>
		<field type="paragraph" subtype="p" label="As part of the response to the July 18 storm, Cypress County will submit an application to the province of Alberta’s Disaster Recovery Program. This program may offer financial relief for uninsurable losses suffered by county residents as a result of the storm." class="paragraph"></field>
		<field type="paragraph" subtype="p" label="Cypress County has agreed to collect this information on behalf of the Alberta Emergency Management Agency (AEMA) which is ultimately responsible for the approval and distribution of any financial relief. " class="paragraph"></field>
		<field type="paragraph" subtype="p" label="Residents who have not already done so are advised to contact their insurance provider in relation to any damage or loss they have suffered as a result of the July 18 storm." class="paragraph"></field>
		<field type="paragraph" subtype="p" label="Pursuant to section 33 (a) of the Freedom of Information and the Protection of Privacy Act, information collected on this form will be shared with the Alberta Emergency Management Agency (AEMA) in their administration of the Disaster Recovery Program under Alberta statute. By clicking the 'Submit' button below, you consent to the information you have provided being shared with AEMA case workers who will contact you directly." class="paragraph"></field>
		<field type="paragraph" subtype="p" label="Please note that the Disaster Recovery Program is not managed or administered by Cypress County. Any questions regarding the collection of this information should be directed to the county FOIP coordinator 816 - 2nd Ave., Dunmore AB T1B 0K3 403-526-2888." class="paragraph"></field>
		<field type="paragraph" subtype="p" label="To contact the Alberta Emergency Management Agency:" class="paragraph"></field>
		<field type="paragraph" subtype="p" label="Hours: 8:15 a.m.-4:30 p.m. (open Monday-Friday, closed statutory holidays)" class="paragraph"></field>
		<field type="paragraph" subtype="p" label="Email: drp.info@gov.ab.ca" class="paragraph"></field>
		<field type="paragraph" subtype="p" label="Phone: 1-888-671-1111" class="paragraph"></field>
		<field type="header" subtype="h2" label="Information" class="header"></field>
		<field type="paragraph" subtype="p" label="The following information relates to the July 18, 2022 wind storm which affected Cypress County." class="paragraph"></field>
		<field type="text" subtype="text" required="true" label="Name" placeholder="Full name" class="form-control text-input" name="text-1660070632747"></field>
		<field type="radio-group" required="true" label="Is this a small business?" class="radio-group" name="radio-group-1660075618940">
			<option value="Yes" selected="true">Yes</option>
			<option value="No">No</option>
		</field>
		<field type="text" subtype="text" required="true" label="Address" class="form-control text-input" name="text-1660075667598"></field>
		<field type="text" subtype="text" required="true" label="Phone number" class="form-control text-input" name="text-1660075691087"></field>
		<field type="text" subtype="email" label="Email address" class="form-control text-input" name="text-1660075708040"></field>
		<field type="text" subtype="text" label="Damage description" class="form-control text-input" name="text-1660075739313"></field>
	</fields>
</form-template>

Skip To Content

Municipality of Cypress County

Quick Links

Property damage collection form

Property damage collection form