Vulnerable Population Registry Application

The purpose of the Burke County Vulnerable Population Registry is to provide emergency responders with important information from individuals that may require assistance during an emergency, e.g.: 

  • Blizzard
  • Disease outbreak
  • Flood
  • Hurricane
  • Power-outage

This program is voluntary and individuals on the registry may decide whether or not to accept assistance. Completion of this form in no way ensures that the individual completing this form will receive immediate or preferential treatment in an emergency. Individuals should maintain a personal emergency plan.

Online Form

Fill out this application online.