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Basic Information

Gender (legal)
1. Female
1. Male
Preferred Pronoun(s)
Height
Weight
Eye Color
Hair Color
Race
Skin Complexion
Body Build
Scars / Marks / Tattoos
Primary Language
School / Camp / Facility Individual Is Affiliated with
Primary Diagnosis / Disability
Other Relevant Medical Conditions / Behaviors in Addition to Primary Diagnosis / Disability (check all that apply)
1. Autism Spectrum Disorder
2. Bipolar
3. Blind
4. Cognitive Impairment
1. Combative / Aggressive
2. Deaf / Hearing Loss
3. Dementia / Alzheimer's
1. Diabetic
2. Down Syndrome
3. Epilepsy
1. No Sense of Danger
2. Non-Verbal
3. Other
Please describe other if not listed.
Identification Information and Where It Is Worn
(i.e. jewelry, tags, ID card, medical alert bracelet, tracking device, etc.)
Prescription Medications
Sensory or Dietary Concerns (If Any)
Additional Information First Responders May Need
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Method of Preferred Verbal Communication
(preferred words, sounds, songs, phrases they may respond to)
Method of Preferred Non-Verbal Communication
(sign language, picture board, written words, communication devices, i-pads, etc.)
Favorite Attractions or Locations Where the Individual May Be Found
List any names of people in the area that the individual might seek out.
(include phone numbers and relations)
Atypical Behaviors or Characteristics of the Individual That May Attract the Attention of First Responders
Individual's Favorite Toys, Objects, Music, Discussion Topics, Likes, or Dislikes
Best Methods to Approach and De-Escalate with the Individual
Does the individual have violent tendencies?
1. Yes
1. No
Please describe any sensitivity to lights, noises, etc.
Please explain any other relevant information.
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