Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Special Needs Shelter Registration Form - Print and Submit

  1. Personal Information

    Please provide your personal information for registration.

  2. Emergency Contact Information

    Please provide the contact information for a local emergency contact.

  3. Additional Qualifying Information

    Please provide the additional information as it relates to your special or specific needs.

  4. Living Situation

  5. Service Animal

  6. Electric Dependant

  7. Use of Oxygen

  8. Caregiver Information

    If applicable, please provide the following information for your caregiver. *SPECIAL NEEDS CLIENTS MUST BE ACCOMPANIED BY SOMEONE THAT IS CAPABLE

  9. Additional Information

    Additional Information

  10. Leave This Blank: