Skip to Main Content
Loading
Loading
I Want To...
Explore Aurora
City Services
Resident Resources
Doing Business
Home
Form Center
Form Center
If "Save Progress" feature doesn't save your progress, please clear your browser cache.
Search Forms:
Search Forms
Select a Category
All Categories
Alderman's Office
Animal Care & Control
Boards & Commissions
Clerk's Office
Community Relations
Contact Forms
Emergency Management Agency (EMA)
Finance
Heritage Boards
Historic Preservation
Innovation & Strategy
Mayor's Office
New Website
Phillips Park Zoo
Planning & Zoning
Police Department
Property Standards
Public Works
Purchasing Division
Special Events
Training
By
signing in or creating an account
, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.
SNAPP Family Member Registration - New
Sign in to Save Progress
This form has been modified since it was saved. Please review all fields before submitting.
Family Member Registration for S.N.A.P.P. (Special Needs Aurora Police Program)
If you have a family member with special needs, please complete this form in its entirety. The Aurora Police Department will submit this information into a database that will assist with how to appropriately interact with this individual if the need arises. Due to the range of needs for those with disabilities, it is important to indicate specific triggers that may be harmful as well as specific ways to interact successfully.
If you have questions about the Special Needs Aurora Police Program,
email Detective Jennifer Hillgoth
, Aurora Police Department, or call her at 630-256-5554.
About Individual with Special Needs
If you are registering yourself, please use the:
SNAPP Self Registration Form.
First Name
*
Middle
*
Last Name
*
Date of Birth
*
Date of Birth
Street Address
*
City
*
State
*
-- Select One --
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Federated States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
*
Gender
*
Race / Ethnicity
*
Height
*
Weight
*
Physical Description
*
Identified Disabilities
*
Emergency Contact Information - Primary
First Name
*
Last Name
*
Street Address
*
City
*
State
*
-- Select One --
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Federated States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Peurto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
*
Phone
*
Relationship
*
Emergency Contact Information - Secondary
First Name
Last Name
Street Address
City
State
-- Select One --
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Federated States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Peurto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Phone
Relationship
Individual's place of employment or educational facility, including address:
Name/address/phone number of any additional caretakers this individual may regularly visit in Aurora:
Triggers, Strategies, and Known Places
Please indicate information that is important for the Aurora Police to know about this individual, including but not limited to special identifiers such as a bracelet noting their disability, verbal/nonverbal, triggers, calming strategies, etc.
Please list any medical needs:
*
Triggers to avoid, if possible:
*
Strategies and/or needs for positive intervention:
*
Do you have any environmental safety concerns such as pets, stored weapons, access to medications or other potential hazards you would like first responders to be aware of?
*
Yes
No
If “yes” is circled, please describe your environmental safety concerns:
Does the individual wear an ID bracelet or alert band?
*
Yes
No
Does the individual wear an ID necklace?
*
Yes
No
Does the individual carry a special needs ID card?
*
Yes
No
Is the individual verbal or nonverbal?
*
Verbal
Nonverbal
Does the individual have an oxygen container?
*
Yes, at home
Yes, at work or school
No
Preferred Language
*
Does the individual have any Sensory Issues?
*
Yes
No
If “yes” is circled above for sensory issues, please describe the sensory issues and provide any suggestions for first responders to best approach and handle in a crisis situation:
Has the registrant been missing before?
*
Yes
No
If yes, where was he/she located and when?
Favorite places to visit:
*
Relationship to Individual
Are you filling out this form on behalf of someone?
*
Yes
No
Relationship to the individual:
*
Your First Name
*
Name of individual completing this form?
Last Name
*
Phone
*
Photo
Is a current photo available to police?
Yes
No
Please upload a current photo of the individual:
Photos can also be emailed to
[email protected]
Please include the individual's name, date of birth, and address when submitting a photo.
This information will be kept on file for a period not to exceed 2 years. A notification will be made prior to that two year deadline. If the information is not confirmed at that time, the information will be removed from the database. If any change in guardianship, in address, or in any other information needs to be made, please complete a new form, including an updated release, and submit it to the Aurora Police Department.
Release
I represent that I am of legal age and capacity and that I represent the above named Individual as the parent or legal guardian (copy of 'letter of office' attached as applicable) and acknowledge that the information provided herein has been given freely and voluntarily and accurately for the sole purpose of assisting police, fire and emergency response agencies to more effectively respond to an emergency or potential emergency which may involve the Individual. I, therefore, on behalf of the Individual, authorize the use of this information for that purpose in the discretion of those police, fire and emergency response agencies who may respond to an emergency or potential emergency involving the Individual. I agree to the dissemination of this information to any police, fire and emergency response agencies which may need access to this information in order to respond to an emergency which may involve the Individual. I acknowledge that by providing this information for the purpose stated above that the Individual is not entitled to any preferential treatment nor a more timely response to any emergency or potential emergency. I agree to keep this information current and acknowledge that the information provided becomes the property of the Aurora Police Department for the purpose stated above. I further for the Individual, his/her heirs, executors, administrators, personnel representatives and assigns, waive and release any and all rights, claims and causes of action arising from participation in SNAPP which they may have against those police, fire and emergency response agencies who may respond to an emergency or potential emergency involving the Individual. I further acknowledge that by providing this information, no relationship nor duty, including but not limited to and contractual agency or special relationship or duty, is established between the Individual and those police, fire and emergency response agencies involving the Individual and that the aforementioned police, fire and emergency response agencies do not waive or limit defense or immunity available to them by law.
eSignature
First Name
*
Last Name
*
Email
*
Date
*
Date
Agreement
I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.
Leave This Blank:
Submit
* indicates a required field
Social Networking
Social Media Policy
Arrow Left
Arrow Right
[]
Slideshow Left Arrow
Slideshow Right Arrow