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Special Needs Registration Form

  1. Primary Emergency Contact Information
  2. Method of communication?

    (If non-verbal; sign language, picture boards, written words, etc.)

  3. Techniques that will attract the individual?

    (Particular voice(mom, dad, etc.), favorite song, etc.)

  4. How would the individual react to sirens, helicopter's, search k9s, people in uniform?
  5. Best methods of approach?

    (Include approach and de-escalation techniques normally used)

  6. Identification worn?

    (Jewelry, Medic Alert, Clothing Tags, ID Card, Tracking Monitor, etc.)

  7. Fascinations and/or stimulants?

    (trains, heavy equipment, airplanes, fire trucks, water, active highway)

  8. Favorite place to go?
  9. If the individual has wandered away before, where was he/she located?
  10. Medical, sensory or dietary issues or requirements?
  11. Additional relevant information.
  12. Secondary Contact Information
  13. Additional Emergency Contact Information
  14. Leave This Blank:

  15. This field is not part of the form submission.