Special Needs Registry Application

Medication Management: You are strongly encouraged to prepare an emergency kit with necessary medical supplies and to keep in that kit an updated list of necessary medications. For information on preparing an emergency kit, plese visit www.ready.gov or www.RedCross.org.

*Pets may not be able to accompany you to the shelter.

Individuals are responsible for caring for the needs of an assistance animal, including bringing food and other essential needs to the shelter. Service animals are allowed in shelters but must provide proof of current rabies vaccine.

By submitting this form I agree or my legal guardian requests that my personal and medical information be added to the Alexander County Special Needs Registry. In the event of an emergency or disaster I hereby authorize the exchange of information between Alexander County, and the local fire department, rescue squad, or law enforcement agency and the individuals and agencies listed on this form. I grant emergency responders permission to enter my home following an emergency event or disaster situation, if necessary, to assure my safety and welfare and for the purposes of evaluating my needs.