Premise Alert Form

Premise Alert Program

The Premise Alert Program is a confidential computer-aided dispatch (CAD) database designed to enhance the safety of people with disabilities/ special needs. These individuals, their families, and/or their caregivers may voluntarily submit information about their special circumstances for inclusion in the Premise Alert Program database free of charge. 

The address associated to the program participant is entered into the database by the Emergency Telecommunicator, which will prompt the alert. This information will then be relayed to public safety personnel who respond to a call for service involving the participant. 

The address alert provides meaningful Information to assist Emergency Telecommunicators and responding agencies with background knowledge of the participants specific disability, medical condition, behavioral issues, violent tendencies, weapons, additional premise access information, caregiver information, etc.

Information pertaining to where the participants live, work and attend school can also be collected, giving responders a valuable resource when they respond to an emergency situation involving a community member with special needs.

Submit The Form Online

"*" indicates required fields

Patient Information

Date Of Birth*
Employer / School Address

Emergency Contact

Emergency Contact Name*
Emergency Contact Email*
Emergency Contact Address*
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