WCDI Emergency Registration Form

It is imperative that all emergency personnel have the information
necessary about Wakefield Residents to rescue you or your loved one in
the case of an emergency. In the case of a town wide disaster, this
information, viewed only by first responders, will give all emergency
personnel the ability to react in a more appropriate, efficient, and
life-saving manner.

Please fill out this form.  We recommend that you request others with a
special need to do so, as well, to receive the necessary assistance.  
Please contact Chief
Michael Sullivan, Wakefield Fire Department, at
781-246-643
5, if you have any questions.  Thank you!
Your Name:
Your Full
Address With
Apartment
and/or Unit
Number:
Your Phone
Number:
Your Special
Need: