Brevard County Special Needs Registration

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Special Needs Registry Login for Administrators

Can't login? Please contact the Special Needs Coordinator at SpecialNeeds@BrevardCounty.us.

Important Information

Special Needs Shelter Application and Information

En Español

Aplicación e Información para Necesidades Especiales de Refugio

Furmularios e Información

Brevard County Special Needs Shelter Registration

Step 1 of 5: Registrant Information

The Brevard County Special Needs Program is a space-limited program for which people with specific health and medical conditions can register, providing sheltering and transportation with the resources available in Brevard County.

The Special Needs Registry is a confidential listing of those people who meet program criteria, and is updated on an annual basis. Patients with colostomy assistance needs, nebulizers, oxygen, feeding tubes, or Alzheimer's disease are examples of medical criteria that are eligible for the registry.

While the Office of Emergency Management recommends sheltering with friends or family members, public shelters are available for those who do not have other alternatives.

Individuals who elect to use a Special Needs or other public shelter should bring with them items such as cots, bedding, medicine, medical supplies, and food supplies, preparing to be self-sufficient for 72 hours. The community pages of the telephone book provide lists of recommended items to take to a shelter. Special Needs registrants should also be accompanied by at least one caregiver.

Most shelters are located in public schools, and offer neither privacy nor luxuries. Occupants' comfort will be determined by their preparedness.

The Special Needs registration request form is here. For more information, call (321) 637-6670.

Information for medical professionals who would like to volunteer at Special Needs shelters is here.

Personal Information (Required)

In order to register online for the Special Needs evacuation shelters, your personal information is required. All required fields are indicated with a red asterisk.

First Name *	Last Name *	MI	Birth Date *	Gender *

Primary Language *	Height	Weight
	ft in		lbs

1st Phone Number *

Type *

2nd Phone Number

Type

Email Address

Address Information (Required)

Please enter your Brevard County home address (no P.O. Box allowed). Address information is separated by street number, street direction, street name, street type, unit type, and unit number. Your city and state is automatically populated based on your zip code.

Community Name	Living Situation *	Residence Type *	Floor Level *

Street Number *	Street Direction	Street Name *	Street Type *	Unit Type	Unit Number

Zip Code *	City, State
	Populated by Zip Code

Check here if your mailing address is different from your home address.

Pet/Service Animal Information (Optional)

Please enter your pet or service animal information.

Number of Cat(s)	Number of Dog(s)	Service Animal Type
Please describe the purpose of your service animal below. (Maximum of 500 characters allowed)
You have characters available.

Security Code:

Please type the Security Code exactly as it appears in the image on the left.

The code is CaSe SeNsItIvE.

This helps prevent automated submissions.

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