Disability Alert Form

Personal Information

Physical Description

Additional Information

Tracking Information

Emergency Contact Information

List Parent, Guardian, Head of Residence, Care Provider, or Conservator

Privacy Disclaimer:

Please note that any information provided herein and shared with law enforcement may not be kept private. The information, including, without limitation, personal characteristics and medical information, may be shared with other law enforcement personnel in an effort to better interact with and/or locate the subject individual and return him/her home safely. By sharing any information contained herein to law enforcement, you represent and warrant that you are authorized to provide the information on behalf of the subject individual, and consent to such information being shared in the sole discretion of law enforcement.