The City of Baytown, serving Special Populations, invites you to complete this survey to help determine your needs in the event of a disaster or evacuation. If you have any questions, you may call 281-420-6556 for further information. Survey to help determine your needs in the event of a disaster or evacuation. Note: Fields marked with a red asterisk (*) are required. Name: * Address where you live: * Zip Code: * Home phone number: * Alternate phone number: * Alternate contact person:   Alternate contact person phone number: In the event of a disaster do you have a plan to evacuate? Select... Yes No   * If YES, what transportation do you plan to use? Select... Car Metro Bus Metro Lift Taxi Other Self Family Friend Volunteer (Church or Club) Local Government Resource Do you have special needs that will affect your ability to evacuate? Select... Yes No   * If YES, please check what type of needs: Medical Equipment Personal Care Assistance Service Animals Other, please describe below   Please indicate 'Other' need