Personal Information of Applicant

Please provide the following information about the individual choosing to provide their information for the Rideau Lakes Vulnerable Persons Registry.

Primary Emergency Contact Information

Please provide the following information about the primary emergency contact for the individual identified above.

Secondary Emergency Contact Information

Please provide the following information about the secondary emergency contact for the individual identified above.

Vulnerable Needs of Applicant

Annual Updates

Select your preferred preferences for your annual updates

I allow the Township of Rideau Lakes to provide the information I included in my VPR registration form to Emergency Responders for use during emergencies. I know that it is important for me to ensure that the VPR program has accurate and up-to-date information at all times. I understand that I still need to call 9-1-1 in an emergency and am also responsible for having an emergency plan in place in order to be prepared to remain safe for at least three days. I recognize that the VPR does not guarantee my safety but is an added safeguard where local emergency service groups will make every effort to increase the possibility of my safety during emergencies.

Personal information contained on this form is collected under the authority of the Municipal Freedom of information and Protection of Privacy Act and will be used for the purpose of fire and emergency services. Questions about this collection should be forwarded to the Township of Rideau Lakes Fire Department.

I consent to the release of my personal information for the purposes indicated above.