Special Needs Emergency Registry Form

Enrolling in the Special Needs Emergency Registry lets police, fire and other first responders in your community better prepare for and respond to your needs during a hurricane, storm, homeland security or any other emergency situation that you may be experiencing.

Many people may need extra help during a time of emergency, including people who:
• Use life support systems such as oxygen, respirator, ventilator, dialysis, pacemaker, or who have chronic conditions and require treatment (e.g., diabetics requiring insulin);
• Have mobility needs and use a wheelchair, scooter, walker, cane, or other mobility device;
• Are visually impaired, blind, hard of hearing, or deaf;
• Have speech, cognitive, developmental or behavioral health challenges; or
• Use assistive animals or a prosthesis.

The information submitted to Stonington’s Special Needs Emergency Registry is shared with local first responders and emergency management officials. Your information is held confidentially and only accessed to assist in your safety and well-being. While enrolling in the registry does not guarantee assistance, this notification allows first responders additional time to consider how to best respond to that incident. Please note that strict confidentiality is maintained at all times and only those who have a reason to access the information are authorized to do so.

Simply expand each category, fill the form as completely as possible and submit it when complete. To download a copy of this form, click here.