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Voluntary Registration for People with Access and Functional Needs

The People with Access and Mobility Needs Registry is a voluntary program for full and part-time residents of Warren County. The registry is designed for residents that may need additional assistance during an emergency. These needs include but are not limited to: temporary limitations, chronic conditions, special healthcare needs, and language barriers. The information that you provide may help responders meet your needs during an emergency. For additional questions call 518-761-6580 or email us using this form

Fields marked with an asterisk (*) are required.

Registrant Details
Physical Address
Is your physical address also your mailing address?
Mailing Address
TDD/TDY (for hearing impaired)
Are you capable of receiving communication in English?
Are you out of state for a period of time?
Emergency Contact
Life Support Systems
Oxygen
Dialysis
Electrical
Do you require a 24 hour caregiver?
Mobility
Are you confined to a bed?
Do you need assistance walking?
Please check any mobility aids that you use:
Mobility Aids
Sensory, Cognitive and Psychiatric Conditions
Please check all conditions that apply:
Evacuation Requirements
Do you need assistance evacuating?
Pets
Do you have pets?
Type of Pets
Have you arranged for your pet(s) to be cared for in the event you need to evacuate?
Will your pet(s) need to be evacuated and sheltered?
By registering, I hereby consent and pre-authorize emergency response personnel to enter my home during search and rescue operations if necessary to assure my safety and welfare during an emergency or natural disaster.