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Online Emergency Registration Form

Registration: City of New Britain Access and Functional Needs Emergency Registry Form


A coalition of community partners has created a completely voluntary registry to supply emergency responders with vital information to assist people who may be vulnerable before, during or after an emergency. Enrollment in this program does not guarantee immediate help, but it allows emergency management officials the ability to plan for your assistance. Personal preparedness is essential; residents of New Britain should always be prepared to support themselves for 4 days after a disaster.


First Name
Last Name
During an emergency will you require assistance to leave your residence?required
Please select all boxes that most appropriately describes your needs or medical problems that you may face during an emergency or evacuation. Select all that apply.required