Special Needs / Address Alert Registry

The Lincoln Park Police Department is making it easier to help our citizens who may be lost, scared or have difficulty communicating with police officers and first responders. With the goal of better serving our residents while responding to call involving individuals with special needs, the Lincoln Park Police Department has established a voluntary Special Need information database. Our officers are trained to recognize how certain circumstances may be distressing to an individual with special needs. By knowing who in our community requires a special response and having that information readily available, our officers will respond appropriately with their needs in mind.

Crisis Communication

Our Special Needs Registry is designed for residents who may be challenged with developmental disabilities or anyone who may have difficulty communicating with emergency personnel. The registry is open to any individual with a physical or mental impairment that subsequently limits one or more major life activities due to a physical and/or intellectual disability.

The registry was created to better assist your loved ones who might be at a higher risk for wandering from home, getting lost, or who have difficulty communicating with others.

Registration

Interested family members and caregivers are asked to complete the registration form below regarding their loved one. This form provides useful information to responding police officers and first responders. To ensure a completed registration form, we are also asking for a current digital photograph of the family member. The information would be kept on file at headquarters and would be accessible at times such as during an encounter where an individual can't tell officers where he/she lives, or would work in cases where a person is reported missing, so that their pedigree and photograph are immediately available to responding officers. The database would only be accessible to law enforcement personnel, and will not be disseminated.

The purpose of the Special Needs Information form is to collect emergency contact information (home address, telephone numbers), as well as specific characteristics with regard to individuals with special needs (i.e., non-verbal, sensory, medical, likes and dislikes). Additionally, a photograph of the individual, if provided, will be attached to their file so that our officers can easily identify them.

The form will remain on file with the Lincoln Park Police Department and the information provided will be kept confidential. Please note that completion of this form is entirely voluntary. If you choose to provide the information requested, you are not obligated to disclose medical information, however, the information provided is extremely helpful to our officers whose purpose is to keep all members of our community safe.

When submitting the form, please include at least one photograph. Once registered, please ensure that pertinent information is kept current by contacting the Community Policing Unit with any changes. We kindly request an annual registration, enabling us to stay up-to-date and have access to an updated photo. Using your loved one's birthdate as a reminder is recommended.

We appreciate the opportunity to better serve our community through this new initiative. Together, let's enhance communication and safety within our community!

For more information, contact us here.

Special Needs Registry

The Lincoln Park Police Department Special Needs Registry is a voluntary service open to all citizens with disabilities who reside, attend school, or are employed within the Borough of Lincoln Park. The registry was created to help police officers and other emergency personnel better assist individuals with special needs in the event of an emergency by providing those first responders with vital information regarding a registrant's disability, emergency contact information, physical description, and current photograph.
NOTE: All individuals who are of legal age (where there is no Power of Attorney or guardianship) can only register themselves.
REGISTRANT INFORMATION
First Name*
Middle Name
Last Name*
Suffix
Address*
City
State
Zip Code
Home Phone #*
Cell phone #*
Date of Birth*
Driver's License Number (if applicable)
Race*
Gender*
Height*
Weight*
Hair Color*
Eye Color*
Complexion*
Facial Hair*
Scars/Marks/Tattoos*
Preferred Name
Please provide a recent photo of the person being registered*
Additional photo (if available)
PERSON COMPLETING THIS FORM (if different from above)
First Name*
Last Name*
Relationship to registrant*
VEHICLE INFORMATION (if applicable)
Does the registrant own or operate a motor vehicle?
1. Yes
2. No
License Plate #
State
Make
Model
License Plate #
State
Make
Model
Does the registrant own or operate a bicycle?
1. Yes
2. No
Make
Model
Speeds
Color
COMMUNICATIONS: (Verbal, Non-Verbal, Sign Language, Speech Difficulty, Picture Communication, Assisted Communication, Non-Communicative, Talker, etc.)
BEHAVIORS/CONSIDERATIONS: (Touch Sensitivity, Noise Sensitivity, Light Sensitivity, Combative, Self-Injurious, Water Attractive, Flight Risk/Wanders, Disrobes, Lack of Eye Contact, etc.)
If runs or wanders, where would he/she go? (Specify places frequented):
Known triggers? (Specific sound/light/gesture that bothers him/her):
ALL INFORMATION WILL BE HELD IN THE LINCOLN PARK POLICE DEPARTMENT'S DATABASE, WILL BE ONLY ACCESSED BY OUR OFFICERS, AND WILL NOT BE DISSEMINATED TO THE PUBLIC. THE INFORMATION PROVIDED IS VOLUNTARY, BUT THE MORE INFORMATION YOU PROVIDE THE BETTER WE WILL BE ABLE TO ASSIST.
EMERGENCY CONTACT #1: First Name*
Last Name*
Relationship*
Address1
Address2
City
State
Zip
Home Phone
Cell phone*
Email*
EMERGENCY CONTACT #2: First Name*
Last Name*
Relationship*
Address1
Address2
City
State
Zip
Home Phone
Cell Phone*

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Email address

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