Specific special needs first responders should be cognizant of
Please choose oneMental HealthPhysical disabilityAlzheimer disease or developmental disabilityAutismNon-ambulatory, wheelchair or walker/caneDeaf/blindSpecific medical needsOther

Individual with Special Needs
Name

DOB

Address

Telephone Number

Concerns, conditions or information that first responders should be aware of

Emergency Contact Information
Name

Address

Telephone Number

Additional Notes

By submitting this form, I understand that this information will remain a part of the East Windsor Police Department’s registry until I request to edit or delete it. I also understand it is my responsibility to notify the East Windsor Police Department of any changes as needed. The East Windsor Police Department will update and evaluate this registry annually.

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