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Vulnerable Persons Registry Form

​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​Brampton Fire and Emergency Services has a Vulnerable Persons Registry List that offers specialized assistance to residents who have disabilities, during an emergency.

To have your name or someone in your household added to the list, please complete the form below and return it to us. Once processed, the identified name(s) and address will be added to our Vulnerable Persons Registry List.

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Please remember to:

  • Update your Vulnerable Persons Registry Form if there are any changes. Your form will be retained for a period of one (1) year from the date received.
  • Notify us if the “Vulnerable Person Resident” no longer resides at the address stated in the form.
  • If you live in a high-rise building, notify your building’s management office as well so that they can add you to the building’s list of occupants who require special assistance. Note: This information is provided only to Brampton Fire and Emergency Services.

Choose one of three ways to submit your Vulnerable Persons Registry Form:

  1. Complete online form below
  2. Mail completed form to:
    • Brampton Fire and Emergency Services
      Communications Division
      425 Chrysler Drive, Brampton, Ontario L6S 6G3​​
  3. Fax completed form​ to: 905.456.5710

Please note: The fields marked * are mandatory.
Status
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Occupants
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Occupant One Age Range*





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Occupant Two Age Range





Please enter the required information.
Please enter the required information.
Occupant Three Age Range





Please enter the required information.
Please enter the required information.
Please enter a valid phone number
Please enter a valid phone number
Reason(s) for Special Assistance. Check all that apply.*
Please enter the required information.
Please enter the required information.
Caregiver
Please enter the required information.
Please enter a valid phone number
Please enter a valid phone number
Emergency Contact
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Please enter a valid phone number
Please enter a valid phone number
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Privacy Statement

Personal information is being collected under the authority of the Municipal Act. The information will only be used to communicate with you regarding your inquiry. Questions about this collection may be directed to Service Brampton by calling 311 (within Brampton city limits) or 905.874.2000 (outside city limits). Please review the City’s Privacy statement for more information.

Contact Brampton Fire and Emergency Services

Headquarters

Mailing Address:

425 Chrysler Drive
Brampton, Ontario
L6S 6G3
Phone: 905.874.2700
Fax: 905.874.2727
Employment Inquiries: 905.874.2150

Always Dial 9-1-1 for Emergencies