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(Required)Email(Required) Ceremony details(Required)Name of person with disability or mobility issues(Required)Mobile phone number(Required)Name of friend or family member assisting(Required)Name of registrar or usher assigned to provide assistance(Required)Details of disability or mobility issueAre they visually impaired?(Required)YesNoHow severe is the visual impairment?(Required)Do they require help to evacuate the premises?(Required)YesNoDo they have a hearing impairment?(Required)YesNoHow severe is the hearing impairment?(Required)Do they require help to evacuate the premises?(Required)YesNoAre they a wheelchair user?(Required)Yes, permanentlyYes, occasionallyNoDo they use a manual or powered chair?(Required)ManualPoweredCan they transfer from the wheelchair to an evacuation chair?(Required)Yes, with no assistanceYes, with assistanceNoAre they able to get down stairs and out exits safely in an emergency?(Required)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?(Required)CrutchesWalking stickWalking frameNoneAre there any further impairments or disabilities that may affect their ability to evacuate the building during fire alarm activations?(Required)YesNoGive details of these impairments or disabilities(Required)