Special Needs Request Form

The City of Inglewood is dedicated to helping individuals who have special needs which require special assistance during an emergency.  We are offering the opportunity to register your needs with the Inglewood Police Department.  By registering with the City, you will be placed on a confidential list of residents with special needs.  This list will be maintained and used during major emergencies to identify you so that we can prioritize our responses.

If you would like to be placed on this list, please complete the online form and be sure to indicate your specific needs.

Special Needs Request









    
OxygenAsthmaWheel Chair
DiabetesWalkerHypertension
SeizuresAlzheimerHearing Impaired
Visually ImpairedSpeech ImpairedDialysis
Power DependentRefrigerator MedicationBreathing Equipment