Specific Needs Registry Form
The Specific Needs Registry is a voluntary program for those persons in Pennington County who may need specific disability-related assistance and/or accommodations in the event of a major disaster. Specific accommodations and assistance needs may include communicating through alternative means, requiring specialized paratransit services, life-sustaining medications, or equipment, etc.
Enrolling in the registry should never be considered as the only action necessary to prepare for disasters, nor does it ensure prompt and thorough response after a disaster strikes. Enrollees should take appropriate measures to become as self-prepared as necessary, given their particular personal situations. Residents of Pennington County are advised to prepare themselves for up to 72 hours of self-sustained survival, should that become necessary.
The form can be mailed or faxed to the Emergency Management Office using either of the following forms.
Specific Needs Form.pdf Specific Needs Form.doc
OR the Registry form can be completed using the online form below.
Confidentiality Statement
Information submitted on this registry form is for the purposes of planning and coordinating emergency responses. Your information will not be shared with unauthorized personnel or organizations. Release of this information to authorized agencies and personnel (which may include first responders such as local fire departments, police and/or sheriff’s departments; shelter personnel; emergency operations center personnel, etc.) will occur only for the purpose of effecting the delivery of aid to enrollees.
Notice of Disclaimer: The Specific Needs Registry is a voluntary program for those persons in Pennington County who may need specific disability-related assistance and/or accommodations in the event of a major disaster. Specific accommodations and assistance needs may include communicating through alternative means, requiring specialized paratransit services, life-sustaining medications or equipment, etc.
Enrolling in the registry should never be considered as the only action necessary to prepare for disasters, nor does it ensure prompt and thorough response after a disaster strikes. Enrollees should take appropriate measures to become as self-prepared as necessary, given their particular personal situations. Residents of Pennington County are advised to prepare themselves for up to 72 hours of self-sustained survival, should that become necessary.