YORK COUNTY SPECIAL NEEDS REGISTRATION FORM

• Do you have someone in your household who is confined to a bed? 
• Do they use a wheelchair or motorized scooter? 
• Do they require medical support equipment (oxygen, ventilator, other)? 
• Do they walk with a walker or a cane? 
• Do they have Alzheimer's or Dementia and are not able to respond to verbal commands? 
• Do they have a developmental or intellectual disability? 
• Is there a service animal? 
• Are they blind, hard of hearing or deaf?

If you answered YES to any of those questions, you can complete the Registration Form and mail to:

YORK COUNTY EMERGENCY MANAGEMENT

120 DAVIES DRIVE

YORK PA 17402

An email and phone number are listed on the form as well.

This is completely voluntary and is NOT mandatory at all.