Special Needs Registry

The Special Needs Registry is an initiative of the Pepper Pike Police Department. The purpose is to provide an opportunity for voluntary reporting of such persons with “special needs” due to mental or neurological disabilities who reside in Pepper Pike, by the person themselves or an adult family member or guardian, so that those with special needs who require special assistance in an emergency or in interactions with PPPD are identiﬁed to PPPD, to increase the department’s ability to meet those needs.

Residents are invited to proactively provide information about a loved one with special needs of any age who may require special assistance in an emergency or interaction with Pepper Pike Police Department.

Frequently Asked Questions

Is the registry voluntary?
Yes, the registry is completely voluntary. None of the ﬁelds on the form are mandatory, and the information you choose to disclose is completely voluntary.

Who is eligible?
The registry has been developed with the intent to serve all members (adult or juvenile) of our community that have a special need and want to register with Pepper Pike Police Department.

How to register?
To register for the Special Needs Registry, complete the Special Needs Registry Form below and it will submit your form directly to the Police Department. If you do not want to submit the form online, you may fill out a printable form and mail or drop it off at the Police Department. Parents and caregivers may enroll a person of any age with any type of 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.

What happens once the person is registered?
Pepper Pike Police Department will maintain the registry. The information provided will assist Police Ofﬁcers, EMS, Fire, Rescue and dispatchers with the information needed to safely and successfully interact and communicate with your loved one, as well as provide us with your contact information.

Who has access to my loved one’s proﬁle?
Pepper Pike Police Department personnel who require this information in the performance of their duties will have access to the information. There are strict regulations concerning accessing and disseminating information. The sharing of information with other ﬁrst responders during an emergency can be helpful when a person is registered. Pepper Pike Police Department will make every effort to respect privacy and conﬁdentiality while providing for the needs of the people involved.

Can I update my proﬁle if there are changes? How do I do that?
You may, however, only information that signiﬁcantly impacts policing response will be necessary. Examples include a change of address, school, or emergency contact. To submit changes please email kmessina@pepperpike.org or jpopov@pepperpike.org with the subject line “Special Needs Registry”. We ask that you review your proﬁle yearly and if possible, to send a new photo every year.

After my child/dependent adult is registered, and there is an incident, do I need to do something to inform the police?
It is preferable that you let the dispatcher or police ofﬁcer know that the individual is already registered. In doing so, the information will be immediately disseminated to on-duty personnel without having to ask the parents/guardians during a high-stress situation.

How will this registry help if my child/dependent goes missing?
If the individual is reported missing by the parent/guardian, information from the registry will be disseminated to on duty personnel in the area to look for the missing person. If the individual has not been reported missing and is incapable of effectively communicating his/her name to an ofﬁcer, coupled with the physical appearance, may allow us to identify the individual more quickly. This will allow us to use the contact information to connect with the parents/guardians.

As soon as I register, will the information be immediately available if a police response is required?
No. The registration form will need to be entered to capture all relevant information. The process may take up to two (2) weeks to fully process.

Pepper Pike Police Department Special Needs Registry

Personal Information for Individual with Special Needs
Legal Name
Nickname(s)
Address1
City
State
Zip
Date of Birth
Cell Phone
Home Phone
Race
Gender
Hair Color
Eye Color
Height
Weight
Scars/Birthmarks/Tattoos/Medical Alert Bracelet
Method(s) of Communication
Primary Language
School
Workplace
Driver’s License/ID Card
Vehicle’s Make/Model/Color
Upload Photo
Emergency Contact Information
Parent/Guardian
Address1
City
State
Zip
Cell Phone
Home Phone
Additional Parent/Guardian
Address1
City
State
Zip
Cell Phone
Home Phone
Special Needs/Disability Information Primary Diagnosis
Additional Diagnosis(s)
Medical Needs/Allergies
Describe Any Unique or Special Behaviors/Characteristics
Describe Best Approach Technique for Responders to Use
Describe what not to do when approaching (if applicable)
Favorite/Commonly Frequented Places
Safe Places Can Be Taken To
Describe Any Sensory, Medical or Dietary Issues
Does this individual have a history of running away?
Is this individual attracted to water?
Can this individual swim?
Additional Information
RELEASE OF INFORMATION
I hereby give my permission to Pepper Pike Police Department to retain and distribute the information contained in this registration form to other First Responders, (including, but not limited to: Police, Fire, EMS, Rescue, and Dispatchers) for the sole purpose of identification and protection of the person identified above, in the event of an emergency or crisis.
First Name
Last Name

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