C.A.R.E Program

The Townsend Police Department has created a registry for individuals with Autism or disabilities in an effort to give police additional information in the event of an emergency.

This program is free for all community members and residents. For additional questions please contact the Townsend Police Department at records@townsendpd.org or call (978) 597-6214.

To be placed on the registry please fill out the form below. For a PDF version of the form click here and return the form to the Townsend Police Department at records@townsendpd.org.

CARE registration form

"*" indicates required fields

Name*

First Last

Date of Birth*

Nickname (or name that should be used to solicit a response)

Address*

Street Address Address Line 2 City State ZIP Code

Home Phone*

Cell Phone*

Other Phone

Race*

Sex*

Height*

Weight*

Eye Color*

Complexion*

Hair Color*

How Worn*

Scars/Marks/Tattoos (If applicable)

Method of Communication? (If non-verbal; sign language, picture boards, written words, etc.)

Techniques that will attract the individual (particular voice (mom, dad, etc.), favorite song, etc.)

How will the individual react to sirens, helicopters, search K9s, people in uniform?

Best methods of approach? (Include approach and de-escalation techniques normally used)

Identification worn? (Jewelry, Medic Alert, Clothing Tags, ID Card, Tracking Monitor, etc.)

Fascinatrions and/or Stimulants? (Trains, Heavy Equipment, Airplanes, Fire Trucks, Water, Active Highway)

Favorite place to go?

If the individual has wandered away before, where was he/she located?

Medical, sensory or dietary issues or requirements?

Additional relevant information

Please upload a recent photo to this form (You can also schedule an appointment to have photograph(s) taken.

Max. file size: 250 MB.

Primary Emergency Contact Information

Primary Contact - Name*

First Last

Primary Contact - Relation*

Primary Contact - DOB*

Primary Contact - Gender*

Primary Contact - Email*

Primary Contact - Address*

Street Address Address Line 2 City State ZIP Code

Primary Contact - Home Phone*

Primary Contact - Cell Phone*

Primary Contact - Other Phone

Primary Contact - Work Address*

Street Address Address Line 2 City State ZIP Code

Secondary Emergency Contact Information

Secondary Contact - Name*

First Last

Secondary Contact - Relation*

Secondary Contact - DOB*

Secondary Contact - Gender*

Secondary Contact - Email*

Secondary Contact - Address*

Street Address Address Line 2 City State ZIP Code

Secondary Contact - Home Phone*

Secondary Contact - Cell Phone*

Secondary Contact - Other Phone

Secondary Contact - Work Address*

Street Address Address Line 2 City State ZIP Code

Additional Information You Feel May Be Helpful