Disaster Assistance Voluntary Registry

The Dane County Disaster Assistance Voluntary Registry has been developed in an effort to identify individuals who cannot safely evacuate their homes in the event of a disaster. Registration does not guarantee any particular emergency services or level of emergency services during a disaster. It will however enhance the ability of emergency management and local officials to meet the emergency needs of the community.

You might want to apply to be on the Disaster Preparedness Registry if you or someone you care for would:

• Need outside help to safely leave your home during a disaster
• Be in jeopardy if you had to stay in your home for three days, without assistance
• Need special notification about the need for evacuation, due to impairment

Online Registration

• Online Registration Website

To Register with a Form

1. Click on the form link below
2. Print out the form
3. Complete the form
4. Send the completed form to the address listed below
5. Further down this webpage in the “Alternative Formats” section there is a “Text Only” alternate format for people who use screen readers with their computer. Instructions on how to fill out the “Text Only” forms are located at the beginning of each “Text Only” document.
   Note: These "text only" forms must be mailed in or hand delivered to the Dane County Emergency Management office.

Form

• Disaster Assistance Voluntary Registry Form (Word Format)
• Disaster Assistance Voluntary Registry Form (PDF Format)

Address

Dane County Emergency Management
Room 2107 Public Safety Building
115 West Doty Street
Madison, WI 53703-3202

Other Information

• Disaster Assistance Voluntary Registry Information
• Frequently Asked Questions

Alternative Formats

• Text Only (for screen readers)

  • Text-Only Registration Form
  • Text-Only Conditions Form
  • Text-Only Release Form

• Spanish Language

  • Spanish Disaster Assistance Voluntary Registry Form (Word Format)
  • Spanish Disaster Assistance Voluntary Registry Form (PDF Format)
  • Spanish Disaster Assistance Voluntary Registry Information
  • Spanish Frequently Asked Questions

• Hmong Language

  • Hmong Disaster Assistance Voluntary Registry Form (Word Format)
  • Hmong Disaster Assistance Voluntary Registry Form (PDF Format)
  • Hmong Disaster Assistance Voluntary Registry Information
  • Hmong Frequently Asked Questions

• Russian Language

  • Russian Disaster Assistance Voluntary Registry Form (Word Format)
  • Russian Disaster Assistance Voluntary Registry Form (PDF Format)
  • Russian Disaster Assistance Voluntary Registry Information
  • Russian Frequently Asked Questions

Contact Information

If you have any questions please contact:

Dane County Emergency Management
Room 2107 Public Safety Building
115 West Doty Street
Madison, WI 53703-3202
Phone: (608) 266-4330 Fax: (608) 266-4500 TTY: (608) 267-1597 Email: maly@co.dane.wi.us