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SNAPP Self Registration - New

  1. Letterhead
  2. Registration for S.N.A.P.P. (Special Needs Aurora Police Program)
    If you have a family member with special needs, or you yourself have any special needs, please complete this form in its entirety. The Aurora Police Department will submit this information into a database which 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 pertinent 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.
  3. About Yourself
  4. Gender*
  5. (eyes/hair/scars/marks/tattoos)
  6. Emergency Contact Information - Primary
  7. Emergency Contact Information - Secondary
  8. Triggers, Strategies, and Known Places
    Please indicate information that is important for the Aurora Police to know about you, including but not limited to special identifiers such as a bracelet noting your disability, verbal/nonverbal, triggers, calming strategies, etc.
  9. Do you wear an ID bracelet or alert band?*
  10. Do you wear an ID necklace?*
  11. Do you carry a special needs ID card?*
  12. Are you verbal or nonverbal?*
  13. Do you have an oxygen container?*
  14. Sensory issues?*
  15. 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?*
  16. (parks, etc.)
  17. Have you been missing before?*
  18. Relationship to Individual
  19. Are you filling out this form on behalf of someone?
  20. Photo
  21. Is a current photo available to police?
  22. Photos can also be emailed to SNAPP. Please include your name, date of birth, and address when submitting a photo.

    This information will be kept on file for a period not to exceed two (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, change in address, etc., needs to be made, please complete a new form along with an updated release and submit to the Aurora Police Department.
  23. Release
    I represent that I, the individual identified below, am of legal age 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 me. I, therefore, 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 me. 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 or potential emergency which may involve me. I acknowledge that by providing this information for the purpose stated above that I am 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 myself, 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 I may have against those police, fire and emergency response agencies who may respond to an emergency or potential emergency involving me. I further acknowledge that by providing this information, no relationship nor duty, including but not limited to any contractual or agency or special relationship or duty, is established between me and against those police, fire and emergency response agencies who may respond to an emergency or potential emergency involving me and that the aforementioned police, fire and emergency response agencies do not waive or limit any defense of immunity available to them by law.
  24. eSignature
  25. Agreement*
  26. Leave This Blank: