The Voluntary Emergency Registry is a list of persons who need help evacuating their home during an emergency, or who would be unable to evacuate without special notification from emergency response personnel. The registry also includes people who would be unable to remain at home without assistance following a disaster.

If you want to be included in the registry, please answer the following questions. Those questions with an asterisk must be answered to advance to the next part of the form. The registration will not be complete until you click "register" on the final enrollment screen.

Please see the AGREEMENT below for information about protecting your privacy.

AGREEMENT

I agree to release the information contained in this application to agencies involved in Emergency Response and Planning.

I understand that I can limit when this information is released by choosing the "Disaster Only" option below. I also understand that registering does not guarantee that I will be evacuated or receive emergency services in a disaster, and that I should still call 911 if I am in a life threatening situation.

NOTE: Every effort will be made to keep your information confidential. In a declared state of emergency, it maybe necessary to release this information to State and Federal agencies coordinating disaster response.

START OF REGISTRATION