Special Needs Emergency Information Form

The Old Bridge Police Department has implemented the utilization of a Special Needs Emergency Information Form. The purpose of this form is to provide the department with emergency contact information (home address, telephone numbers), as well as specific characteristics with regard to individuals with special needs (i.e., non-verbal, sensory, medical, likes and dislikes).

The department is requesting your assistance in completing the Special Needs Emergency Information Form and attaching a photograph of the individual with special needs in order that we may better serve the residents of our community. The form will remain on file with the Police Department and the information provided to the department will be kept confidential.

The completion of this form is entirely on a voluntary basis. If you choose to provide the information requested, you are not obligated to disclose medical information.

Letter from Chief William A.  Volkert 

Special Needs Emergency Info Form