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Special Needs Reunification Registry Form


  1. 1. Demographics
  2. 2. Medical Information
  3. 3. Additional Information
  4. 4. Criminal Warning
  5. 5. Consent Statement
  • Demographics

    1. Facial Recognition Opt-Out
    2. Please submit a clear, good quality photo (JPEG) that is face forward, from the shoulders up, without distracting colors, patterns, or other faces in the background.

    3. Corrective Lens
    4. Home Address
    5. Does the Individual Live Alone?
    6. Does the registrant own or frequently drive a vehicle?