Baca County Special Needs Program
Dear Neighbor,
The Special Needs Program, in cooperation with local churches and the emergency services agencies, is
creating a database containing information about individuals within the town who have special needs that may
require assistance in the event of a disaster. The information may also be used to assist emergency personnel
and volunteers in providing assistance. Participation and registration in this program is voluntary.
Our mission is to assess and plan for hazards and emergencies and work with other public safety and
municipal agencies to ensure public welfare. As a pre-planning tool, registration should be considered for all
people who have special medical needs (i.e. oxygen or life support systems that are dependent upon electrical
power) or have physical disabilities that would make it difficult to independently follow public safety
directions, such as evacuation, if the need arose. Reasonable efforts will be used to protect this information
including pursuing legal action to prevent disclosure when deemed necessary. However, this does not warrant
that the information provided will be held confidential under the Colorado Open Records Act. Please do not
provide information that you believe would compromise your security.
If you have further questions regarding this program or any other needs that you may have, please feel free
to contact your local law enforcement office, the public health department, home health or the pastor of your
church or any other clergy person within the county.
Thank you,
Special Needs Committee
Baca County Sheriff’s Office
265 E 2
nd
Ave
Springfield, CO 81073
719-523-4511
Springfield Police Department
748 Main St.
Springfield, CO 81073
719-523-6241
Campo Police Department
PO Box 116
Campo, CO 81029
719-787-2416
Walsh Police Department
401 N Colorado
Walsh, CO 81090
719-324-5566
Baca County Public Health
741 Main St. Suite 4
Springfield, CO 81073
719-523-6621
Baca County Special Needs Program
Baca County Special Needs Program
741 Main St.
Suite # 4.
Springfield, Colorado
81073
Phone: 719-523-6621
Fax: 719-523-6537
Liability Release Agreement
Effective Date ____/____/______
The undersigned agrees and does hereby release from all liability and hold harmless the Baca
County Special Needs Program and any of its volunteers representing or related to the Baca County
Special Needs Program.
This liability release is for any and all liability for personal injuries including death and property
losses or damage in connection with any activity or accommodation of the above mentioned
Organization.
Applicable Law
This contract shall be governed by the laws of the State of Colorado in Baca County and any
applicable Federal Law.
______________________________ Date____________
Signature of Participant
______________________________ Print Name