Special Needs Registry Form


Township of Maplewood/Maplewood Police Department Special Needs Identification Program

TO ALL COMMUNITY MEMBERS: The Township of Maplewood in conjunction with the Maplewood Police Department has established a Special Needs Identification Program. This program is available to any Maplewood Township resident with a special needs diagnosis who is voluntarily requesting to enroll in the program (diagnosis such as: Autism, Dementia, Bi-Polar Disorder, Schizophrenia, or other illness, condition, or “Special Need” that may cause someone to become impaired).

  • 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. *This voluntary information is solely entered in our computer system. It is intended for information purposes only and will not be shared.*
  • 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.

Police Officers receive specific training to follow protocols when they contact persons with “Special Needs”. It would greatly help if The Maplewood PD was able to understand who the individual is prior to making contact. This prior knowledge will aid in better communication which will lead to a safer resolution for all involved parties.

Special Needs Registry Form:

Please add all the following helpful information which will assist the first responders. Please feel free to add what the applicant likes and dislikes. Possible information to add:

  • Noise, Sound, Touch sensitivities
  • Medication they may be taking
  • Places they frequent
  • Topics to easily discuss to put the individual at ease

Be Advised: 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 Lieutenant Chris Black at (973) 762-3400 ext. 7882 or Officer Jones at (973) 762-3400 ext. 7924 for any assistance. Thank You.

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

Applicant Information
Please complete all fields.
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png.
Please describe applicant's medical condition.
1) Emergency Contact Information
2) Emergency Contact Information (Optional)