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Jupiter Police Department Special Needs Registry

  1. How to Register

    To register for the Special Needs Registry, complete the form below, print it and turn it into the Jupiter Police Department. Parents and caregivers may enroll a person of any age with any type of medical condition or disability, including but not limited to: Autism Spectrum Disorder, Alzheimer’s or Dementia, Bipolar Disorder and Down Syndrome. Adults with special needs may also enroll themselves.

  2. Photo of Jupiter Police Department Patch

  3. What happens once the person is registered?

    When a Police Officer has contact with the person on this form, our 911 center can provide us with the information needed to successfully interact and communicate with your loved one, as well as provide us with your contact information.

  4. CONTACT INFORMATION

    Person with Special Needs:

  5. RESIDENCE INFORMATION

  6. PARENT OR GUARDIAN INFORMATION

    First Parent or Guardian

  7. Second Parent or Guardian

  8. DISABILITY / SPECIAL NEED

  9. EMERGENCY CONTACT INFORMATION

    First Emergency Contact

  10. Second Emergency Contact

  11. PLEASE READ AND AGREE

  12. By checking the box below I agree, I am the lawful and legal parent and/or guardian of the person with special needs listed in this safety roster:

  13. I agree and understand the information provided to the Jupiter Police Department is for law enforcement to have all the necessary information to better handle a situation and that information may be subject to public records laws, - however, special needs are protected under FSS 252.355(5) and will be redacted when necessary

  14. RELEASE OF INFORMATION

    I, hereby give my permission for the Jupiter Police Department to retain and distribute the information contained in this registration form to other first responder personnel for the sole purpose of identification and protection of the person identified above in an emergency or crisis situation.

  15. Please Print this form and sign above

  16. Final Instructions

    Please fill out the form in its entirety and click the print button below. After printing the form please bring it to the Jupiter Police Station at 196 Military Trail, Jupiter, FL 33458. Please note The process may take up to two (2) weeks to be fully processed. You will receive a wrist band with a “number” when you register and an identification card that will be mailed to you from the police department.

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