This Emergency Needs Registry website allows residents and businesses where persons with special needs reside an opportunity to provide information to emergency response agencies to better plan to serve them in a disaster or other emergency. The information collected here will not be available to the public. It will only be shared with emergency response agencies to improve their ability to serve.

Please be as complete as possible in your responses. You will be contacted occasionally to ensure the information is correct and to make any necessary changes.

If you have any questions, please contact Roanoke Emergency Management. By submitting your information, you agree that you voluntarily authorize its release.

Individual Registration
Name:
Address:
City:
State:
Zip:
Home Phone Number:
T.T.Y. Number(If applicable):
Cell Phone Number:
Is your cell phone your primary telephone and registered with the Office of Emergency Management's Reverse 911 system?
If not, click R911 Registry to register. R911 Registry
Email:
Date of Birth:
RadDatePicker
RadDatePicker
Open the calendar popup.
Gender:
Medical Needs - Check any of the medical conditions that apply.
Are you able to walk without assistance?
-If no, do you depend on:
Social Needs
Do you have or can you arrange your own transportation in the event of an evacuation?
Do you rely on public transportation or taxi service for your primary transportation?
What is your primary Language for communication?
Do you have a Service Animal?
Emergency Point of Contact (relative, friend, neighbor, etc)
Name:
Relationship:
Phone Number:
Additional Information you feel is important for the registry to have:
By submitting this information, you agree to give local law enforcement personnel, Office of Emergency Management designees and responders permission to enter your home in the case of an emergency to assist in care and/or evacuation.