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Spartanburg County Office of Emergency Management

Copyright © 2006 "www.scoem.org"  ·  All Rights reserved

Special Needs Registry

If you have a mental or physical impairment and your level of care would go beyond the normal first aid level found in a public shelter, then please register!!

Name:
Address:
City:
State:
Zip:
Home Phone:
Cell Phone:
Specify Disabilities
Primary Contact
Address for Primary Contact:
City:
State:
Zip:
Phone for Primary Contact:
Relationship with Contact:
Are You Oxygen Dependent:
Special Medications:
Can you evacuate on your own?