Access & Functional Needs Emergency Assistance Questionnaire

In the event of an emergency or disaster, some residents may need assistance during evacuation and sheltering. The Office of Emergency Management maintains a voluntary registration list of individuals to make response agencies aware of those who need assistance. THIS INFORMATION WILL BE KEPT CONFIDENTIAL AND USED ONLY IN THE CASE OF AN EMERGENCY OR DISASTER. It does not guarantee the agencies will be able to provide assistance in every type of emergency. Wayne / Monroe Counties shall not be made liable for any claim based upon the good faith failure to exercise or perform a function or duty on the part of any officer or employee in carrying out a local disaster preparedness plan. If you no longer live at the address to which this form was sent, please indicate your correct address.

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⊳ Please click here to download the Access & Functional Needs reply card.