Special Needs Registry Form

Residential Special Needs Assistance Form

Dear Resident,

The Borough of Fair Lawn Office of Emergency Management maintains a Residential Special Needs Registry for citizens who may require special attention during times of emergency. If you or someone you know is using oxygen in their home, is homebound, confined to a wheelchair, is on dialysis, or has any other form of physical or mental disability, please take a few moments to fill out this application. 

Please be assured that all information is kept confidential and is distributed to the police, fire, rescue, ambulance, health, and public works departments for use during an emergency.

Be sure to fill out and return the form to:

Fair Lawn Emergency Management
ATTN: Special Needs Registry
8-01 Fair Lawn Avenue
Fair Lawn, New Jersey 07410