Get Special Needs Application - Highlands County

This guide provides clear, step-by-step instructions on how to complete the Special Needs Application for Highlands County online. It aims to support users in accurately filling out the form to ensure their special needs are addressed in emergency situations.

Follow the steps to successfully complete your application.

1. Click ‘Get Form’ button to access the Special Needs Application and open it in your browser.
2. Begin filling out the form by entering your name and date of birth. Clearly print your name to avoid any potential errors.
3. Provide your address, including street, city, and ZIP code. Ensure that your contact information, including phone numbers, is current.
4. Indicate your gender and provide your height, weight, and age. These details help the shelter prepare for your specific needs.
5. Select your primary language preference from the options provided. If you speak a language not listed, specify it in the designated area.
6. Identify the caregiver who will assist you in the shelter. Be sure to include their relationship to you and their contact numbers.
7. Fill in directions to your home to help emergency responders reach you if needed.
8. Select the type of residence you live in: single family home, manufactured home, apartment/condo, or subdivision/complex/park.
9. List your medical providers, including your primary doctor, home health agency, oxygen provider, and any other medical support providers along with their contact numbers.
10. Indicate your home care information, specifying if you can care for yourself, or if you require nursing assistance.
11. Complete the special and medical needs section by marking all applicable items to ensure the shelter understands your requirements.
12. Detail the medications you take, including dosage and the prescribing physician's contact information.
13. Specify your transportation requirements and note if you need assistance with transportation to the shelter.
14. Outline your sheltering plan in case you cannot return home, including alternative contacts.
15. Ensure to read and sign the statement of understanding, acknowledging the information provided is correct and that you understand the terms of registration.
16. Once completed, review the form for accuracy. Save your changes, and if necessary, download, print, or share the form as needed.

Complete the Special Needs Application online today to ensure your safety and support during emergencies.