Vulnerable Population Registry

The Vulnerable Population Registry is a tool that first responders can use to evaluate resident needs and assist in emergency response. While registering does not guarantee that you will be provided services or placed in a priority list for responders, it does help responders be better able to meet your needs in an emergency. This information is confidential and will only be shared with first responders in the case of an emergency situation like an evacuation. You can remove yourself from this list at any time. The City of Aumsville will be contacting you aproximately once a year to verify the information you've submitted is still correct. If you need to update or change any of your information, please contact Aumsville City Hall at 503-749-2030, or resubmit this form and we can update your information in our database.

Supporting Documents

Vulnerable At-Risk Resident Form (117 KB)

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Name of Person Who Will Need Assistance *

Date of Birth *

Street Address *

Home Phone

Cell Phone

Accepts Text Messages *

Yes

Check Each Box That Applies *

Mobility issues

Medical assistance device which requires electricity

Name of Relative *

Relative or other person we can notify to help you in the event of an emergency or evacuation

Address of Relative *

Phone Number of Relative *

Email for Relative *

Signature *

By typing my name I understand that my participation in this registry is voluntary, and that all information I provide will only be used for emergency planning and response purposes. I can ask that my name be removed at any time by contacting the City of Aumsville with this request. This information is to aid emergency responders, registration does not guarantee emergency services will be rendered during an emergency or disaster. I understand that it is my responsibility to make emergency preparations, including provision of medications, medical equipment and supplies, and dietary items. I understand that I should call 911 if I am in an emergency. I confirm that this information is true and correct and if this information changes I will promptly contact the City of Aumsville with updates.

Leave this field blank

Vulnerable Population Registry

Supporting Documents

Contact Information