Create a Website Account - Manage notification subscriptions, save form progress and more.
Fill out the form with as much information as you would want to be shared with emergency first responders, sign it, and then return a copy to your child’s teacher and the school will send all forms to the local police department - or you may mail it back to your local police department. The information will be put into the police system for future use.
Show All Answers
Anyone who has a special need, health challenge or disability such as, but not limited to, Alzheimer’s Disease, Autism, Mental Health Challenges, Intellectual Disability, a complex or rare medical condition, who would like first responders such as Police, ambulance and fire department to know of their special needs.
Those who can fill out and submit the Premise Alert System Request Form (PDF) include:
If you do not have a legal right to provide this information, you should not fill out this form or provide this information.
No, it is voluntary. You do not have to provide any information you do not want first responders to know or use.
It will depend on where you reside.
Any picture is better than no picture, but the best picture is a close-up of the person’s face. A passport or school picture would suffice. It is best if the background is plain.
This form is good for 1 to 2 years depending on the system it is filed in. If you move or need to make changes to the information, just fill out another form and submit it. Any of the police departments will automatically use the new information.