If any portion or pages of this web site are inaccessible to you, please contact Nickole Cheron, Disability Program Co-coordinator @ 503 823 2036, Nickole.Cheron@ci.portland.or.us to request alternative formats.

The Voluntary Emergency Registry is a list of persons who need help evacuating their home during an emergency, or who would be unable to evacuate without special notification from emergency response personnel. The registry also includes people who would be unable to remain at home without assistance following a disaster. Information in this list will be provided to the Bureau of Emergency Communications (911) and other emergency response personnel from the City of Portland and Gresham and Multnomah County.

If you want to be included in the registry, please answer the following questions. Those questions with an asterisk must be answered to advance to the next part of the form. The registration will not be complete until you click " register" on the final enrollment screen.

Please see the AGREEMENT below for information about protecting your privacy. You may also contact either the City of Portland (503-823-2036) or the Multnomah County Aging and Disability Helpline (503-988-3646) for more information or assistance in registering.

AGREEMENT

I agree to release the information contained in this application to the following agencies involved in Emergency Response and Planning:

• Portland Office of Emergency Management (includes Neighborhood Emergency Teams)
• Gresham Office of Emergency Management
• Multnomah County Office of Emergency Management
• City of Portland Disability Program
• Department of County Human Services
• Multnomah County Health Department
• 911 (includes Police and Fire )

I understand that I can limit when this information is released by choosing the "Disaster Only" option below. I also understand that registering does not guarantee that I will be evacuated or receive emergency services in a disaster, and that I should still call 911 if I am in a life threatening situation.

NOTE: Every effort will be made to keep your information confidential. In a declared state of emergency, it maybe necessary to release this information to State and Federal agencies coordinating disaster response.

START OF REGISTRATION