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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.
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.
Person with Special Needs:
First Parent or Guardian
Second Parent or Guardian
First Emergency Contact
Second Emergency Contact
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.
Please Print this form and sign above
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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