Harrison County
Hurricane Evacuation Transportation
Registration Form
ALL INFORMATION MUST BE COMPLETED!

AFTER COMPLETING FORM, ENTER ANSWER (X + X), AND SELECT “SUBMIT FORM.” SEE “MESSAGE SENT” MESSAGE TO KNOW THAT IT WAS SUBMITTED. CONTACT CTA WITH ANY QUESTIONS OR TO CONFIRM REGISTRATION.

Hurricane Evacuation Registration

Date

Registration Information:

Name

Email Address

Address

City

ZIP Code

Home Phone

Cell or Other Phone Number:

Total Number of people to be picked up

Please specify the number of people in the appropriate category:

Seniors (60+)

Adult (18-59)

Disabled

Children

Special Medical Support Needed? Special Medical Support Needed? Yes No

Medical Support Type Medical Support Type Wheelchair Walker Oxygen Dialysis

Other

Do you need to shelter a pet? Do you need to shelter a pet? Yes No

Type and Size of Pet Type and Size of Pet Dog Cat Bird Pocket Pet (no snakes/lizards) Large Medium Small

Basic Information about service:

1. Must be ready for pick up at the Evacuation Start Time set by Harrison County Emergency Management Agency, monitor local media outlets for information. (i.e. if the evacuation is set to start on Monday at 9:00am, be ready on Monday at 9:00am)
2. Transportation to a local shelter is determined by your residence and shelter location, passenger cannot specify what shelter they will be transported to.
3. Baggage limited to TWO (2) Carryon Sized Bags per person that can be stored under their seat or held in lap. Baggage must be packed and ready to go when bus arrives. Bus will not wait for you to pack your bags.
4. Passengers responsible to bring their own supplies to shelter: water, nonperishable foods, prescription and non-prescription medications, oxygen tanks, baby formula, wipes and diapers, etc.
5. Qualified pets must be in a pet carrier when the bus arrives and accompanied by owner during transportation.
6. If you are not going to go to the evacuation shelter, please call CTA to cancel the ride.
Coast Transit Authority, 333 Debuys Road, Gulfport, MS 228-896-8080, Fax (228) 896-8081

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