In the event that you are activated to respond to an emergency: Please list additional person(s) who may be used to contact you if we are unable to reach you using the information provided above.
What languages do you speak or understand other than English? Please list and indicate level of fluency. (Include sign language)
During a Non-Emergency Situation
Privacy Act Statement:
This information is requested by the DeKalb County Board of Health for the purpose of organizing volunteers and staff to respond to public health emergencies. It will not be utilized or released for any other purpose without your express written permission unless required by law.