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The Special Needs
Evacuation Registration Form is available in .pdf
format which allows you to view the form online and print it. You
will need the Adobe Acrobat Reader to view the file. If you do not
have the Adobe Acrobat Reader, click below to download it.
Printable Registration Form
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Download Adobe Acrobat Reader
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After you have printed and completed the
registration form, please mail it to:
Office of
Emergency Management
11 North 14th Street, Suite 12
Fernandina Beach, FL 32034
This information is requested pursuant
to Section 252.355, Florida Statutes which also mandates that
all information contained in this form is confidential and
exempt from disclosure and can be made available only to other
emergency response agencies.
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