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Voluntary Cognitive Deficit / Special Needs Informational Form


  1. 1. Step One
  2. 2. Step Two
  3. 3. Step Three
  4. 4. Step Four
  • Step One

    1. Form Top
    2. Project First Responder
    3. Voluntary Cognitive Deficit / Special Needs Informational Form
    4. This program allows families to provide critical information to first responders before they have any type of interaction. Information provided includes methods of communication, sensory and medical issues, as well as approach and de-escalation techniques. Responding to this form is voluntary, but please provide all the detail that you can, using other paper if necessary. This information will be provided to emergency responders when coming in contact with the person named on this form, or at the address listed. This form requires a signature on the last page and may be filled out by the individual with the specific disability, their parent/guardian, foster family, legal representative or legal guardian. (A signature is required to process the information contained on the form).
    5. Vehicle Associated:
    6. Caretaker Information