Forms home Personal Emergency Evacuation Plan form Complete this form at least 48 hours in advance of the wedding/civil partnership/citizenship ceremony. You will need to complete a form for each person with a disability or mobility issues attending on the day.Name of person completing this form*Email* Ceremony details*Name of person with disability or mobility issues*Mobile phone number*Name of friend or family member assisting*Name of registrar or usher assigned to provide assistance*Details of disability or mobility issueAre they visually impaired?*YesNoHow severe is the visual impairment?*Do they require help to evacuate the premises?*YesNoDo they have a hearing impairment?*YesNoHow severe is the hearing impairment?*Do they require help to evacuate the premises?*YesNoAre they a wheelchair user?*Yes, permanentlyYes, occasionallyNoDo they use a manual or powered chair?*ManualPoweredCan they transfer from the wheelchair to an evacuation chair?*Yes, with no assistanceYes, with assistanceNoAre they able to get down stairs and out exits safely in an emergency?*Yes, completely independentlyYes, with some supportYes, with support and evacuation chairNoIf the person is not a wheelchair user, what other mobility aids do they use?*CrutchesWalking stickWalking frameNoneAre there any further impairments or disabilities that may affect their ability to evacuate the building during fire alarm activations?*YesNoGive details of these impairments or disabilities*