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