Skip to Main Content
Business & Development
How Do I…
Select a Category
Advisory Board & Committee Interest Form
Engineering, Architectural Design, Transportation and Mobility
Fire Rescue and Beach Safety
Human Resources & Risk Management
Parks Recreation and Cultural Arts
signing in or creating an account
, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.
Sign in to Save Progress
Autism Outreach Program
This form has been modified since it was saved. Please review all fields before submitting.
Thank you for visiting our Autism Outreach page. Please take a moment to fill out the application to become a part of our voluntary program.
Does the Individual Live Alone?
Date of Birth
Individual's Physical Description
Please Upload a Photo of the Individual
Additional Relevant Information
Prescription Medications Needed
Sensory or Dietary Issues
Other Medical Conditions
No Sense of Danger
Prone to Seizures
If Other, Please Explain
Additional Information For First Responders
Emergency Contact Information
Name of Emergency Contact (Parents, Guardians, Care Providers)
Emergency Contact Address
Emergency Contact Phone Numbers
Name and Phone Number of Alternate Emergency Contact
Information Specific To The Individual
Favorite Attractions or Locations Where the Individual May be Found
Behaviors/Characteristics of the Individual That May Attract the Attention of Responders
Individual’s Favorite Toys, Objects, Music, Discussion Topics, Likes, or Dislikes
Method of Preferred Communication (If Non-Verbal: Sign Language, Picture Boards, Written Words, Etc.)
Method of Preferred Communication (If Verbal: Words, Sounds, Sings, Phrases)
Identification (ID Card, Medical Alert Bracelet, Jewelry, Tags, Etc.)
Tracking Information (Does the Individual Have a Project Lifesaver, LoJack SafetyNet Transmitter Number?)
Individual May React Negatively If:
Leave This Blank:
Receive an email copy of this form.
This field is not part of the form submission.
* indicates a required field
Code of Ordinances
Flood Zone Map
Slideshow Left Arrow
Slideshow Right Arrow