Special Needs Program - Enrollment Form

Leave This Blank:

The Special Needs Program is provided to enhance service to members of our community and ensure vital information is available to public safety and emergency responders.

Information will remain confidential and only be used by emergency response agancies.

The following information is required to enroll in the City of New Braunfels Special Needs Program:
Please indicate Special Need(s), examples may include:
If applicable, please answer the following in the event of an evacuation order:
By checking below I indicate that I understand the above and authorize the New Braunfels 9-1-1 Emergency Communications Division to add the information provided to their computer files for use in the event of an emergency. Once enrolled, it is very important that the information be updated as required.
* indicates required fields.