High Priority Disaster Response Registry

Fredericton High Priority Disaster Response Registry for Vulnerable Seniors and Persons with Disabilities.

When the registration is received, you will be contacted to review the information to confirm your registration.
Authorized release will only occur during an emergency to effect delivery of aid to the registered party or to verify registration.

I am registering

I am registering myself

I am registering someone else on their behalf

Registrant Information

Name of Registrant

Gender

Date of Birth

Home Address

Phone

First language

Building contact/Landlord phone (if applicable)

Emergency Contact Information

Name of Emergency Contact

Relationship to Registrant

Phone (cell)

Phone (home)

Phone (work)

Emergency Considerations

Please note any information that could be relevant to emergency responders if they are required in an emergency:

Hearing Impairment

Sight Impairment

Service animals of pets

Security system in place

Mobility aids

Critical medications

Other:

When the registration is received, you will be contacted to review the information to confirm your registration.

I authorize the information to be maintained confidentially by the Fredericton Public Safety Communications Centre for use only during an emergency that may affect me in my home or to contact me to verify information for the registry.

Authorized release will only occur during an emergency to effect delivery of aid to the registered part or to verify registration.

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