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Special Needs Registration

  1. Shorewood Police Department

    The Shorewood Police Department recognizes that some residents and visitors may have special needs that impacts how they interact with first responders. With that in mind, we have developed a special needs registration form. 

    The information obtained will be used to enhance the safety of the community and provide a more informed response to those with special needs during an emergency.   If interested, please complete the special needs registration form below and click SUBMIT at the bottom of the screen. A PDF version of this form is available upon request.   

    Questions regarding the Special Needs Registry can be directed to Captain Fernando Santiago at 414-847-2610, or emailed at

  2. Does the person live alone?
  3. Medical Alert worn
  4. Are they likely to wander off?
  5. Visually impaired?
  6. Hearing Impaired?
  7. Is the person:
  8. Does the person have violent tendencies?
  9. Emergency Contact information - 1
  10. Emergency Contact - 2
  11. Disclaimer

    Responding to this form is strictly voluntary. The information on this form will be added to the Shorewood Police Department’s record management system, and may be distributed to emergency responders in order to better care for you or your family members. Once submitted, this form is a public record, and may be subject to disclosure under WI Stat.§19.35, except as otherwise exempted by law. The Village does not collect or maintain information about you that is not essential for your safety and well-being. By completing this Special Needs Registry form, I acknowledge that the information provided herein is accurate, and was submitted voluntarily for the sole purpose of assisting Police, Fire and Emergency Response Departments in more effectively responding to a potential emergency in or near my residence. I, therefore, authorize the use of this information for those purposes.

  12. Leave This Blank:

  13. This field is not part of the form submission.