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 781-246-6435, if you have any
questions.  Thank you!
Your Name:
Your Full
Address With
Apartment
and/or Unit
Number:
Your Phone
Number:
Your Special
Need: