Special Needs Alerts and Identification Participation Form

If you are a parent, guardian, or caregiver of an individual with medically diagnosed special needs, please complete the following form to participate in the program. Answer all questions completely and accurately as this information will be utilized to create the alert in our database. If you have a question regarding any portion of the form, send an email to SAId@NormanOK.gov.
     
Information on the Individual in need of S.A.Id Alert
     
     
     
     
     
     
     
     
     
     
     
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Please list any Physical Identifiers (Scars/Marks/Tattoos/Physical Conditions)

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Please upload a recent photo of the individual (5MB size limit)

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(Check All That Apply)

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(Check All That Apply)

     
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Primary Emergency Contact

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Secondary Emergency Contact

     
     
     
     
     
     
     
     
     
     
     
     
     
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Would you be interested in receiving additional information on how to obtain a piece of identification jewelry created with the individual's specific S.A.Id alert number?

     

By submitting this form, I certify that the information provided is true and accurate to the best of my knowledge. I understand that I voluntarily provided this information listed in this form and that it will not result in any type of preferential treatment from First Responders. I hereby grant the Norman Police Department to create an alert utilizing the above information and consent to that information being shared with the Norman Fire Department and Norman Regional Hospital’s EMSSTAT Paramedics and Ambulance Service.

     
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