Occupant with Autism Program

Welcome to the Miami-Dade Police Department's "Occupant with Autism Program" registration form. This initiative assists officers in identifying homes and vehicles of individuals with autism. Participation is voluntary, offering the option of a decal for additional awareness. Please fill out this form to register and help us enhance our service.
Parent/Guardian/Self Information:
Additional Contact Information:
Occupant with Autism Information:
Gender
Required
Race
Required
Hair Color
Required
Eye Color
Required
Identifying Features (scars/birthmarks, tattoos)
Required
Communication Type
Required
Comments
Please provide any additional information; i.e. responsiveness, tends to wander, special instructions
Under penalties of perjury, I declare that I have read the foregoing registration document and that the facts stated in it are true.
Required
Sign Here
Required

Type your name below to generate a signature.