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Elyria Police Autism Alert Response

The EPD Autism Alert Response Form is a document designed to help Elyria Police Officers identify and understand the unique needs of individuals with autism spectrum disorder (ASD) during encounters. The form is also an invaluable tool when officers are searching for missing children with ASD, as it provides critical, pre-collected information that helps officers respond more effectively and proficiently.

The main goals of the form are to provide critical information rapidly, enhance officer awareness and sensitivity, improve safety during interactions, facilitate fast recovery during missing persons incidents, support effective communication, and build collaboration with caregivers and families. The form should be completed by parents, guardians, or caregivers.

The Elyria Police Department is committed to fostering an inclusive and supportive environment for individuals with ASD, utilizing specialized training to prioritize awareness, communication, and tailored responses to best serve the needs of our ASD population and their families.

To fill out and submit this form online continue below. For a printable version of this form Click Here.

Autism Alert Response Form
This form is intended to assist persons at risk
Name
Address
Does he/she carry any special identification?

EMERGENCY CONTACTS

Contact Name
Address
Contact Name
Address
Contact Name
Address
Is he/she verbal or non-verbal?
Is he/she sensitive to noise?
Is he/she sensitive to touch?
Eye Contact
Does he/she run away from home or school?
Does he/she have any specific fears?
Click or drag files to this area to upload. You can upload up to 4 files.
This includes any relevant photos that would help relocate during an elopement encounter

RELEASE

I give my permission to the Elyria Police Department to retain and distribute this information to first responders/law enforcement personnel for the sole purpose of identification and assistance to the person at risk.

Your name here will act as your signature
Date / Time
Email
Leave your email to receive a confirmation and a copy of the form as submitted.
Leave your phone number if you wish to be contacted about your form submission.