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Autism Alert Registration

  1. The Autistic Individual
  2. Does this person wander and does he/she have favorite attractions or places where they may be found: (ie. playground, near water, woods, etc.)
  3. Please provide any other pertinent information that could be useful for first responders such as: method to approach and de-escalation techniques, reinforces that are used to de-escalate and/or promote cooperation (ie: likes to hold pens, etc.)
  4. Please provide any information that could be useful for first reponders on what not to do when dealing with the autistic individual. (ie. Physical contact, direct eye contact, bright lights, loud noises, etc.)
  5. Primary Emergency Contact and Information
  6. 2nd Emergency Contact and Information
  7. Notice
    All information obtained from this application is confidential and is NOT a public record. The information on this applicatin shall only be used for it's intended purpose, to portect an endangered person. It is also acknowledged that it is your responsibility to make sure that the information provided is accurate and that the North Kingstown Police Department will be notified if there are any changes.
  8. By typing your name above, you are in fact offering your electronic signature and ack\ this submission as accurate and factual.
  9. Leave This Blank:

  10. This field is not part of the form submission.