Resident Assistance Program (RAP)

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In times of crisis, it’s nice to know someone has your back.

The City of Punta Gorda Fire Department has developed a Resident Assistance Program (RAP) to help residents with disabilities or other special needs during a disaster or emergency situation. The goal of the program is to create a database of those people who may require enhanced assistance due to disability or medical issues. This information will allow us to better provide aid and manage resources.

This program does not take the place of the Charlotte County Special Needs Registry. Punta Gorda residents with special needs are encouraged to participate in both programs. For more information on the County program follow this link https://snr.floridadisaster.org/Signin?client=charlotte.

Registration in the program is free and open to anyone with a disability or special need who lives in the City of Punta Gorda. Access to the information you provide is limited to the City of Punta Gorda Fire Department.

Register online with the form below.

Please correct the fields below:

Please correct the field(s) marked in red below:

All submitted information is strictly confidential

1

Resident Information

*

Resident Information

First Name

MI

Last Name

Address1

Address2

City

Zip

E-mail

Residence phone#ext.

Cellphone#ext.

2

Family or friend contact information

*

Family or friend contact information

Name of nearest relative/friend not living with you

Their contact phone#ext.

3

CHECK ALL THAT APPLY

I require assistance with ambulation

I require assistance with medication

I require observation by a Health Professional

I have a service animal

I require electricity for life-sustaining medical equipment

I require basic nursing care

To receive a copy of your submission, please fill out your email address below and submit.
Email Address

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Resident Assistance Program (RAP)