Riviera Beach Police Department Special Needs Registry

Riviera Beach Police Department Special Needs Registry

The Riviera Beach Police Department's Special Needs Registry is an outreach program that will allow our officers to better serve those in our community living with autism or living with other cognitive impairments. Through this program, we hope to maintain a database of individuals we may interact with in hopes of improving our response.
The form below is to be filled out with information about the person with autism or other cognitive impairment. This form will be sent directly to the Community Services Unit of the Riviera Beach Police Department. The information will be kept confidential and made available only to law enforcement entities. This process will allow officers who are responding to an incident involving a person registered in the Special Needs Registry to appropriately prepare for and handle the situation based on the information provided. Ultimately, through the RBPD Special Needs Registry, we aim to improve these interactions for all parties involved.

For more information, please contact the Riviera Beach Police Department’s non-emergency number at (561) 845-4123, reach out directly to Officer Knight with the Community Services Division at (561) 635-7587, or email us at specialneedsregistry@rbpublicsafety.org.

To have a person removed from the program or to make any updates/changes to their information, please email specialneedsregistry@rbpublicsafety.org. Be sure to include the reason for removal or the updated information, along with your contact details for any follow-up questions we may have.
Please check that you understand that:*

I am registering for myself or am a parent or legal guardian and have proof to upload Proof of GuardianshipI have compiled all medical documents to certify the disability or condition into one PDF to upload
Personal information for individual with Special Needs:
Full Name*

First NameLast Name
Preferred Name (Nickname)
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth:*

MonthDayYear
Date
Cell Phone Number:
Please enter a valid phone number.
Home Phone Number:
Please enter a valid phone number.
Race or Ethnicity
Gender*
Hair Color*
Eye Color*
Weight*
Height
Vehicle Type
Make
Model
Color
Scars, marks, tattoos, body markings, amputations.
Please provide a current photograph of the registrant to Police Records.

Cancelof
Personal Information for Primary Parent/Guardian Information:
Name

First NameLast Name
Primary Phone Number
Please enter a valid phone number.
Secondary Phone Number
Please enter a valid phone number.
Email
example@example.com
Place of Employment
Relationship to Registrant
Address if different than registrant

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Additional Parent, Guardian, or emergency contact:
Name

First NameLast Name
Primary Phone Number
Please enter a valid phone number.
Secondary Phone Number
Please enter a valid phone number.
Email
example@example.com
Place of Employment
Relationship to registrant
Address if different than registrant

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Special Need/ Disability
Primary Diagnosis
Co-Existing Diagnosis
Notes
Please check all conditions or circumstances that apply:

ADHDAggressive with Police/FireAsthmaAutismBi-PolarDown SyndromeEpilepsyHearing ImpairmentHistory of Baker ActMentally/Memory ImpairedMobility IssuesOppositional Defiant DisorderPTSDSeizuresSensory IssuesSpeech ImpairmentsTraumatic Brain InjuryVisual Impairment
If other, please explain.
Sensory or dietary issues, if any.
Additional information first responders may need.*
Specific Information
If nonverbal, how does the registrant communicate (e.g. pictures or devices):
Does the registrant have any communication disabilities (e.g. echolalia, delayed answering, narrow interests, etc.)
Any items or actions that would cause the registrant to become agitated or shut down:
Any items or actions that would help the registrant to become calm:
Any other additional information about the registrant not listed above:
Please Read and Initial:
I am the lawful and legal parent and/or guardian of the person with special needs listed in this safety roster:
Signature
Relationship
I understand the information provided to the Riviera Beach Police Department is for law enforcement to have all the necessary information to better handle a situation and that some information may be subject to public records laws - however, special needs are protected under FSS 252.355(5) and will be redacted when necessary.
Signature
I understand the information provided to the Riviera Beach Police Department is for law enforcement to have all the necessary information to better handle a situation and that some information may be subject to public records laws - however, special needs are protected under FSS 252.355(5) and will be redacted when necessary. I, hereby give my permission for the Riviera Beach Police Department to retain and distribute the information contained in this registration form to other first responder personnel for the sole purpose of identification and protection of the person identified above in an emergency or crisis situation.
Signature
Date

MonthDayYear
Date
Frequently Asked Questions

What is the Riviera Beach Police Department’s Special Needs Registry?

The Special Needs Registry is an initiative of the Riviera Beach Police Department. Its purpose is to compile and maintain a list of individuals who have “special needs” due to mental or neurological disabilities and who may reside or frequently visit the City of Riviera Beach. Residents are invited to proactively provide information about a loved one with special needs of any age, who may require special assistance in an emergency or interaction with Riviera Beach Police Officers. The registration is completely voluntary.

How to register

To register for the Special Needs Registry, complete the Special Needs Registry Form and turn it into the Riviera Beach Police Department. If a person over 18, with a disability has been declared incapacitated, a parent or legal guardian of the person may enroll him or her in the registry with any type of medical condition or disability, including but not limited to: Autism Spectrum Disorder, Alzheimer’s or Dementia, Bipolar Disorder and Down Syndrome. Adults with special needs may also enroll themselves.

HB 1275: Persons with Disabilities Registry requires that proof of parentage, guardianship, or other legal authority be provided to local law enforcement at the time of registration of a minor or ward, which may include, but need not be limited to, proof of parentage or guardianship, as applicable:

A birth certificate as described in s. 382.013, F.S.;
A power of attorney, as defined in s. 709.2102(9), F.S.;
Letters of guardianship as described in s. 744.345, F.S.
A court order establishing parental rights or guardianship; or

What happens once the person is registered?

When a Police Officer has contact with the person on this form, our 911 center can provide us with the information needed to successfully interact and communicate with your loved one, as well as provide us with your contact information.

Who has access to my child's profile?

Riviera Beach Police personnel who require this information in the performance of their duties will have access to the information. There are strict regulations with respect to accessing and disseminating information. The sharing of this information with other police agencies during an emergency can be helpful when a person is registered in Riviera Beach but wanders off in another jurisdiction.

Can I update my profile if there are changes? How do I do that?

You may, however, only information that has a significant impact on policing response will be necessary. Some examples would include a change in address, school, or emergency contact. You do not need to report a change in hair cut or color, for example, as the police are familiar with the changes that can be made and are more likely to notice height, weight and eye color. Changes can be made on a new registry form.

After my child/dependent adult is registered, and if there is an incident, do I need to do something to notify the police?

It is preferable that you let the police know that the individual is already registered. In doing so, the information will be immediately disseminated to the officers without having to ask the parents/guardians during a high stress situation.

How will this registry help if my child/dependent adult goes missing?

If the individual goes missing and is reported by the parent/guardian, information about his/her physical appearance, the most likely places where he/she would go to, as well as triggers, stimulants, and de-escalation techniques will be sent to every police officer in the area to look for the missing person. If the individual has not been reported and is incapable of effectively communicating his/her name to an officer, a computer check of the neighborhood, coupled with the physical appearance, and may allow us to identify the individual more quickly. This will then allow us to use the contact information to connect with the parents/guardians.

As soon as I register, will the information be immediately available in case police response is required?

No. After receiving your registry, a liaison will be in contact with the person registering or the caregiver to review all information. Once everything is confirmed, the registration form will need to be entered in order to capture all relevant information. The process may take up to two (2) weeks to be fully processed.
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