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Special Needs Registery

  1. PD Form LH.jpg

  2. The Township of Maplewood in conjunction with the Maplewood Police Department has established a Special Needs Identification Program. This program is available to any township resident with a special needs diagnosis who voluntarily requests to enroll in the program. This program consists of a voluntarily on-line registration. Once an individual has been registered an entry will be placed in the Township of Maplewood Police Department CAD (Computer Aided Dispatch) name information file. The individuals guardian will then be contacted by a member of the Maplewood Police Department and they will be provided with a Special Needs Identification Card, which will consist of the individuals name, address, date of birth, emergency contact information, diagnosis and any special instruction provided to the Township of Maplewood Police Department in the comment section of the on-line fill able form. Please complete all fields.

  3. Any and all information provided in the form is provided voluntarily.

  4. Please complete all fields.

  5. Month/Day/Year

  6. Please describe applicant's medical condition.

  7. Please add all the helpful information that will assist the first responders. Please feel free to add what the applicant likes and dislikes, so this will help the first responders with the initial contact.

  8. All of the above information will be put into our CAD system, which will provide our first responders with all of the vital information. Please call Sergeant Christopher Black or Sergeant Michael Palmerezzi at 973-762-3402 for assistance.

    This field is not part of the form submission.

  9. Leave This Blank:

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574 Valley St.
Maplewood Township, NJ 07040
Hours of Operation 9:00 am - 4:30 pm
Ph: (973) 762-8120