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5. Guardian Program

   The Ocoee Police Department is pleased to offer a program to assist our citizens with special needs. The Guardian Program is designed to expedite the safe return of persons with special needs to their loved ones and provide valuable information during responses to their home. The program consists of a database that allows you to enroll and submit identifying information of the person and specify their special needs as well as any other instructions that can help our first responders better understand how to interact with them. Once the information you submit is received, it will be stored in a database visible only to Police personnel. The database will then become an additional tool to be used when first responders encounter someone who has been enrolled and in need of help, especially if that person is unable to verbally communicate. If at any time, you need to update or delete information about a previously entered individual, you may contact  Sergeant Beck at  KBeck@ocoee.org.

   
   

   If you want to register for the program but do not wish to affix the decal to your home, simply fill out the form below and request zero decals. This will enable to flag the address in our dispatch system, so arriving officers will be aware that a person with autism lives in the home or is travelling in a vehicle.

7. Special Needs Person's Name*
8. Type Of Disability *
   -- Select One --AutismAlzheimer/DementiaOther (Please Explain in Special Instructions)
9. Autism Only Please Select Sticker Amount
   -- Select One --01234
11. Special Needs Person’s Street Address*
    i.e., 646 Ocoee Commerce Pkwy
13. Special Needs Person's Zip Code*
15. Date of Birth *
    Date of Birth
17. Gender*

    1. Male
    2. Female
19. Race/Ethnicity*

    1. American Indian or Alaska Native
    2. Asian
    3. Black or African American
    4. Hispanic or Latino

    1. Native Hawaiian or Other Pacific Islander
    2. Two or More Races
    3. White
21. Height*
23. Weight*
25. Native Language*
27. Does the individual have any scars, marks or tattoos?*

    1. Yes
    2. No
29. If yes, please describe below.
31. Preferred method of communication*

    1. Verbal
    2. Non-verbal
33. Potential to run away or elope?*

    1. High
    2. Medium
    3. Low
    4. N/A
35. Special Instructions*
    If you would like to provide any information or attributes exhibited by your loved one that would benefit First Responders when interacting with them, please describe it above. i.e., medications, behaviors, likes or dislikes.
37. Caregive/Legal Guardian/Parent*
39. Emergency Contact Address*
    i.e., 646 Ocoee Commerce Pkwy
41. Emergency Contact Person's Zip Code*
43. Primary Phone*
    For emergency contact.
45. Email*
    Caregiver/Legal Guardian/Parent
47. Secondary Phone
49. Photo
    Please upload a current photo of the special needs person that will help Police easily identify them.
51. Verification*

    1. I have reviewed the information provided above and have verified that it is correct.
Leave This Blank:


53. 1. Receive an email copy of this form.
54. Email address

    This field is not part of the form submission.

55. Submit

* indicates a required field