Family emergency plan

What this gives you

Fill this in on your phone — it takes about fifteen minutes — then print it and keep it at home with your important papers. If you are ever detained, this is the page a caregiver, a relative or a lawyer picks up and knows what to do.

What you end up with

One page a caregiver, a relative or a lawyer can pick up and act on.
Who would care for your children, and who to call first.
Doctors, medicines and allergies — yours and your children’s.
What is due every month, and who can help pay it.
Nothing is required. Fill in what you know, print it, and add the rest by hand.

Everything you type stays on this phone or computer. Nothing is sent to us — we never see it.

This plan saves itself on this device as you type, so you can stop and come back. You can erase it anytime with Start over.

Three rules for this plan

Do not carry this plan with you. Keep it at home, in the safe place where you keep your passport, your prescriptions and your immigration papers.
Tell only people you trust where it is — not what is in it. Make sure at least one of them can actually get to it if you are arrested.
Never show this plan to ICE, and never hand it to an officer.

These three rules print with your plan, at the top of the page.

Losing TPS is not a deportation order

TPS for Haiti and Syria was terminated effective July 27, 2026, and TPS work permits expired the same day. That is not an automatic deportation order. Removal requires a legal process, and in that process you have rights — the ones on this card. A written plan is how a family stays organized while that plays out.

Know your rights if ICE comes →

General information, not legal advice. This worksheet organizes information you already have. It does not create any legal document, and naming a caregiver here does not give that person legal authority. For your own case, talk to a licensed immigration attorney or a DOJ-accredited representative — free and low-cost help is here.

About me

My full name

Social Security or ITIN number, if you have one optional

Optional — leave it blank if you are unsure. A printed plan does not need it.

Home phone

Cell phone

Place of birth

Languages I speak

I need an interpreter for English

Phone number of the nearest Haitian consulate

Emergency contacts

Pick people who will answer an unknown number. Ask them first.

Emergency contact 1

Name

Phone

Emergency contact 2

Name

Phone

Other important family names and numbers

Name and number 1

Name and number 2

Name and number 3

Name and number 4

My children’s caregiver

The trusted adult who would care for my children if I could not.

Caregiver’s full name

Their address

Their phone

Their relationship to me

Their relationship to my children

Already set up

My children know this person and know how to reach them.

My children’s school has this person listed as an emergency contact.

My children’s doctor has this person listed as an emergency contact.

Ask a lawyer about this one

Writing a caregiver’s name here does not give them legal authority. Ask a lawyer about a Caregiver Authorization Affidavit or a Power of Attorney so this person can make decisions for your children if it is ever needed. We do not create that document for you. Free legal help: find it here.

In Florida, one specific thing to ask about: a Designation of Health Care Surrogate for a Minor (Florida Statutes § 765.2035). It lets the person you name make medical decisions for your child. It needs two adult witnesses, no notary, no court, and no fee — and the statute itself includes a fill-in form (§ 765.2038). The person you name cannot be one of the witnesses. Bring it to your legal appointment and ask if it fits your family.

Doctors, medicines, allergies

My doctor’s name

My doctor’s phone

Medicines I take, and the dose for each

One medicine per line.

My allergies, or a special diet I follow

My children’s doctor — name

My children’s doctor — phone

Medicines my children take, and the dose for each

One medicine per line. Write the child’s name next to it.

My children’s allergies, or a special diet they follow

Childcare provider — name

Childcare provider — phone

Money and bills

Names only — no account numbers

Write the name of the bank or credit union, never the full account number. This page gets printed and left in a folder; a printed plan should not expose your accounts. Keep account numbers in your safe place, separate from this plan.

Banks or credit unions I use — names only

What is due every month

Rent or mortgage Amount Due date

Utilities Amount Due date

Car Amount Due date

Phone Amount Due date

Other Amount Due date

Who can help pay the bills or manage money if I am not here

This person is already an authorized user on one of my accounts.

Where emergency cash is kept

Where financial documents are kept

My lawyer

Lawyer or advisor 1 — name and phone

Lawyer or advisor 2 — name and phone

Lawyer or advisor 3 — name and phone

No lawyer yet? Free and low-cost immigration legal help, city by city, is at tpssurvivalguide.com/help/. Never pay a “notario” — they are not lawyers in the United States.

Talking with my children

In simple words, at their age, tell your children three things: who would take care of them if you were not home; how to call that person, another trusted adult, or 911; and that they should not open the door for anyone unless they know it is safe. Then practice the answers below until they can say them without reading.

My child’s full name, the way they practice saying it

Our home address, the way they practice saying it

The phone number they are memorizing

Last time we practiced

Review log

A plan goes stale. Check it twice a year, and every time something below changes.

Last reviewed

Next review

What changed

We moved.

My job changed.

My children’s school or doctor changed.

The caregiver’s information changed.

Check it and print

What is on your plan

Anything you left blank prints as an empty line — you can fill it in by hand after you print. Press Change on any section to go back to it.

Know your rights

These rights belong to you no matter what happened to your immigration status.

You can stay silent. You do not have to answer questions about where you were born or what your immigration status is.
You can refuse a search. If an officer asks to search you or your home, you can say: “I do not consent to a search.”
Ask for a lawyer right away if you are detained or questioned, and do not sign anything before you speak to one.
Never carry false papers or documents from another country. It can turn a hard situation into a criminal one.

The Immigrant Legal Resource Center publishes a free Know Your Rights “Red Card” in Haitian Creole that you can print and carry: ILRC Red Card in Kreyòl (PDF, ilrc.org). Our own wallet card is at /print-card/.

Tip: set your printer to “Fit to page,” and print two copies — one for your folder at home, one for the person who would come for your children. Starting over erases everything you typed, including anything saved on this device.

Plan structure based on materials by the Immigrant Defense Project — immdefense.org/raids. Inspired by community preparedness work by Haitian Bridge Alliance.

General information, not legal advice. Nothing on this page creates a legal document or an attorney-client relationship. Find free legal help →

The Kreyòl labels on the Kreyòl version of this worksheet come from community source documents.

Find free legal help near you →
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