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Special Needs Program - Enrollment Form

  1. 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.

  2. The following information is required to enroll in the City of New Braunfels Special Needs Program:
  3. Please check one of the following:
  4. Please indicate Special Need(s), examples may include:
  5. Check any that apply:
  6. If applicable, please answer the following in the event of an evacuation order:
  7. Check any that apply:
  8. 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.
  9. Check if applicable:*
  10. Leave This Blank: