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The information provided will be shared with emergency responders in the event of a 9-1-1 call and used by our staff to identify and allocate the proper resources needed at your residence / business. The information provided will be kept on file for one year. A new form will be mailed annually (in January) to verify the need for your information to be maintained. Forms must be resubmitted annually.
By submitting this form, it is comparable to a legal signature.
Examples: Oxygen in use, ventilators, confinement to a wheelchair / bed; bariatric issues. Residential access concerns such as gate codes or driveways that are not accessible for emergency vehicles should be listed also.
The following should be contacts that could respond to assist emergency responders in entering or securing your residence / business in the event of an emergency.
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