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Special Needs Database
Do you need assistance in an emergency? Are you disabled or have any special needs? If you answered “yes” then please consider signing up for our voluntary Special Needs Database, a confidential residential listing of people with special needs. The database will be used by Croton Public Safety Agencies  (Police, Fire and EMS) as a way to help you during emergency situations.

The information contained on this form will not be made public but may, in the case of an emergency, be shared with police, fire and EMS personnel.

Special Needs (check all that apply)
CheckboxesCheckbox DescriptionCheckboxesCheckbox Description
Vision Impaired
Speech Disability
Hearing Disability
Need assistance during emergency evacuation
Assistance Walking
Wheelchair
Bedridden
Medicine dependent
Service animal dependent
Meals/food assistance
Electric dependent (give details below)
 
 
Please provide the following information:
Field DescriptionField DataRequired Field
required
required