Emergency & Evacuation Planning

Emergency & Evacuation Planning Form for Senior Citizens and Citizens with Special Needs

The Orinda Police Department maintains a database of seniors and people with special needs who may require evacuation and shelter assistance during a disaster situation.

People with medical disabilities or transportation needs are encouraged to register with the Orinda Police Department for these services.

People who register will be asked to keep their information current and to update it annually. Personal information will be kept confidential in accordance with state and federal law, and will be maintained by the Orinda Police Department. Data will only be used by emergency personnel during preparedness planning and evacuations.

Please PRINT and COMPLETE THIS FORM in it's entirety. 

Registration Instructions:

A separate form is required for each individual requesting evacuation registration. Please retain a copy for your records.

Please Answer ALL questions.

If your form is missing information (such as correct phone number, address, etc.) we may not be able to contact you. We cannot determine your needs unless you answer ALL questions regarding any medical and transportation requirements. Upon receipt of your completed form, your information will be entered into our restricted database.

Keep your registration information current.

You are responsible for informing the Health Department of any changes. If you move, change your phone number, or no longer need to be registered, let us know immediately so your file can be updated. If we cannot contact you during an emergency evacuation, we cannot assist you.

• This registry will be updated annually.

• Registrants are responsible for updating their own forms online annually.

• Registrants who DO NOT update forms or cannot be reached will be removed from our registry.

• Registration is FREE and VOLUNTARY. Your information is used solely by those public health and safety agencies who will assist you during an emergency. It does not imply or guarantee any other service.

Please mail your COMPLETED form to:

Orinda Police Department: Attn Emergency & Evacuation Planning

22 Orinda Way, Orinda, CA 94563

Questions or concerns may be directed to the Orinda Police Department 925-254-6820.