By filling out this form I give my authorization for the medical information contained herein to be released to the county health department, emergency management, local fire districts and receiving facilities for the purpose of evaluating my needs and providing emergency transportation and sheltering. Records relating to registration of disabled citizens are exempt for the provisions of F.S. 119.07(1), Public Records Law. The information contained here will be kept confidential.
E-mail addresses are public records under Florida law and are not exempt from public-records requirements. If you do not want your e-mail address to be subject to being released pursuant to a public-records request, do not send electronic mail to this entity. Instead contact this office at 727-464-3800, or fax to: 727-464-4024, or in writing, via the United States Postal Service to
Office of Emergency Management
Public Safety Complex
10750 Ulmerton Rd.
Building 1, Suite 267
Largo, FL 33778
Special Needs/Evacuation Assistance Program