Disabilities and Special Needs Premise Alert Registration

The Riverwoods Police Department, along with the Lincolnshire-Riverwoods Fire Protection District and the Deerfield-Bannockburn Fire Protection District, offer a Premise Alert Program (PAP) in support of individuals living with disabilities or special needs as well as police and emergency medical personnel responding to calls at a related address. Individuals with disabilities or special needs wishing to participate in the program may supply information to be kept in our computer aided dispatch (CAD) database free of charge. Information may also be supplied by the individual’s family members, friends, caregivers, or medical personnel familiar with the individual. When a 911 operator sends police or emergency medical personnel to an address in the database, the information will be passed on to the emergency responders. The information gathered as part of PAP shall remain strictly confidential and will be used only to provide assistance to the emergency medical and police responders.

Individuals with disabilities are those with a physical or mental impairment that substantially limits one or more of the major life activities. 

Individuals with special needs are those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require mental health and related services of a type or amount beyond that required by individuals generally.

The intent of the Premise Alert Program is to afford people with special needs or disabilities the same access to public safety services provided to all citizens. Provision of the information will not result in preferential treatment, but it will enhance the ability of emergency responders to effectively deal with those individuals.

The form must be filled out every two years. Information not renewed after two years will be removed. 

For other Senior Services and Disability Programs offered by the Village of Riverwoods, click here.

Date
Resident Birthdate
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png.
List Employer or school address and telephone number.
List all additional emergency contact names, relationships, addresses, phone numbers, and emails
List all medications first responders should be aware of.
How does this medication affect actions, responses, senses, potential for violence, etc...?
Please list any suggestions, techniques, or actions that can be taken to successfully resolve a confrontation
This person is:
Check all that apply.
Please list any "Activations" or "Triggers" which may escalate an encounter. What actions should be avoided by 1st responders?
List all additional emergency contact names, relationships, addresses, phone numbers, and emails
If not completed by the resident.
Completing Party Date of Birth
If not completed by the resident.
If not completed by the resident.
If not completed by the resident.