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Autism Alert Form

  1. The Madison Police Department, is offering a voluntary registry service for people with disabilities who may require special assistance in emergency or crisis situations. This confidential registry may provide essential information that will assist police, fire, EMS and other emergency workers to safely address the needs of residents of all abilities.

    This information is protected and will be stored in our Dispatch CAD system and will only be accessible to dispatchers and 1st Responders when there is a call for service at the corresponding address.  

  2. Vocal, Sign Language, Pictures, Written, Etc. 

  3. Other Relevant Conditions in Addition to Autism*

    Check all that apply

  4. Please include known De-Escalation Techniques 

  5. Medical Alert, Clothing Tags, ID Cards, Tracking Monitor, Etc. 

  6. Leave This Blank:

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