Special Needs Form

If you are a resident of Greenland who requires special needs in the event of an emergency, please provide the information requested below.

This information will be used only if the Emergency Operations Center (EOC) becomes activated in the event of fire, EMS or other circumstances.   It is important that this information be kept up to date.  This information is maintained in a secure area

Please print and complete the form below.  The completed form may be left at the Greenland Town Office, mailed or e-mailed to the Greenland Volunteer Fire Department.

Link to Special Needs Form MSWord.doc

Special Needs Form

Return to: Greenland Fire Department, Attention: Special Needs PO Box 100 Greenland NH 03840

Name:                                                                                               Today's Date:

Street Address:

 

Date of Birth:

Special Needs or Medical Concerns: