Respond With Care: Special Needs AWARENESS Program

Respond With Care: Special Needs AWARENESS Program

Request a vehicle sticker and share important information to help first responders better assist individuals with special needs during emergencies.
This voluntary form allows families to request a Respond With Care vehicle sticker and, if they choose, share limited information to help first responders better assist a loved one with special needs.

Information provided may be added as a note to the home address in the 911 system and is only visible to emergency responders if a 911 call is made to that address.

The vehicle sticker serves as a visual reminder for responders to proceed with care. The sticker is a visual indicator only and does not contain or link to any personal information.
Caregiver Name*

First NameLast Name
Caregiver Phone Number*
Please enter a valid phone number.
Section 2: Who the Sticker Is For?
Name of Individual*

First NameLast Name
Age (optional)
Section 3: Information for First Responders
Communication Considerations (check all that apply)

Limited or non-verbalDifficulty understanding instructionsUses assistive device or communication aidMay not respond to questionsOther
Behavior / Safety Considerations (check all that apply)

May become anxious or overwhelmedSensitive to loud noises or lightsMay not tolerate physical contactMay wander or attempt to leaveNo known safety concernsOther
Helpful Information for Responders
This section is optional. Share anything you feel would help responders provide the best care.
Section 4: Home Address (Optional)

This information is optional. If provided, it allows a note to be added to the address for emergency responders.
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Section 5: Sticker Request
How many stickers are you requesting?*
Sticker Pickup Location*

Pick up at McDowell County Sheriff's OfficePick up at McDowell County Emergency Services HeadquartersSticker already provided
Should be Empty:

Respond With Care: Special Needs AWARENESS Program

Section 2: Who the Sticker Is For?

Section 3: Information for First Responders

Section 4: Home Address (Optional)

Section 5: Sticker Request