Special Needs Alert Form

Oakland County Sheriff's Office. All fields marked * are required.

Subject Information

First Name *

Middle Name

Last Name *

Date of Birth *

Gender

Race

Height

Weight

Eye Color

Hair Color

Identifying Features

Photos (optional) Up to 5 photos. JPG or PNG only. Max 5 MB per photo.

Subject Primary Address

Address

Apt / Suite

City

State

Zip Code

Location Description

Medical & Behavioral

Condition / Diagnosis

Primary Diagnosis

Medical Information

Critical Information

De-escalation Techniques

Behavioral Triggers

Guardians

At least one guardian with a primary phone number is required.

Guardian Name

Primary Phone

Alternate Phone

Relationship

If Other, specify

Submitter

Your Name *

Your Primary Phone *

Your Email *

Relationship to Person

If Other, specify

Consents

I hereby give my permission for the Oakland County Sheriff's Office to retain and distribute the information contained in this registration form to other first responder personnel for identification and protection purposes in emergency situations. *

I hereby give my permission for the Oakland County Sheriff's Office to retain and distribute any image associated with this registration form to other first responder personnel for identification and protection purposes. *