Sloan, NY · Erie County
Emergency Response Dataform
Sloan residents can use this form to share household, medical, and emergency contact information with local emergency responders.
What this form is
The Emergency Response Dataform lets residents tell emergency responders about disabilities, medical needs, household members, pets, and other details that may help during an emergency. The form encourages residents to complete and return it so responders can better understand their situation. It asks for household and contact information, physician details, and answers about medical equipment, mobility, hearing or vision, and transportation needs.
Who needs it
Sloan residents with a household member who has a disability or special medical need should complete the form and provide relevant emergency information.
How to submit it
Mail the completed form to AVERT, 425 Reiman Street, Sloan, NY 14212. The form lists (716) 897-1560 for questions.
About notarization
No notary is required; the form asks for a completion date and does not request a signature or sworn attachment.
How to submit this form
- 1
Download the Form
Download the Emergency Response Dataform PDF.
- 2
Complete the Form
Provide household, contact, physician, and emergency-needs information, then enter the date completed.
- 3
Add Helpful Information
Use the reverse side to add any other information you feel would be helpful to know.
- 4
Mail the Form
Mail it to AVERT, 425 Reiman Street, Sloan, NY 14212.
Frequently asked questions
- What is the Emergency Response Dataform for?
- It lets Sloan residents share household details, medical needs, and emergency contacts that may help responders when answering a call for help.
- Who should complete this form?
- The form is intended for residents with a household member who has a disability or special medical need. It asks about medical equipment, mobility, and other emergency needs.
- How do I submit the Emergency Response Dataform?
- Mail the completed form to AVERT, 425 Reiman Street, Sloan, NY 14212. For questions, the form lists (716) 897-1560.
- Do I need a notary for the Emergency Response Dataform?
- No. The form asks for a completion date but does not request a signature or sworn attachment.