IN CASE OF AN EMERGENCY DIAL 9-1-1           NON-EMERGENCY LINE (352) 249-2790

Register Someone with Autism/Dementia

Law enforcement is frequently called to find a wandering senior who is suffering from dementia or one of our young citizens who is suffering from some form of Autism.  We want to be able to respond compassionately as well as professionally.  

By completing this form, you are helping local law enforcement know how to treat your loved one should you ever have an emergency. With the information provided in the form below about your special needs family member, we will add a unique alert button to the address as well as their name in our closed records system.  If you should call for help, our 9-1-1 Communications Officers will inform responding deputies about the special needs so they may interact appropriately when encountering your family member.  We appreciate your assistance and hope this will help if you and/or family member ever have an emergency situation.


* indicates required fields


Persons Information

Caregiver / Emergency Contact Information

Form Completed By