Autism and Special Needs Registry

The Autism and Special Needs Registry is a program available to Special Needs Citizens who reside in Walworth County. While the program is maintained through the Walworth County Sheriff’s Office, due to the best interest of all Walworth County citizens, police departments from all jurisdictions in Walworth County will work together to share and maintain information provided to help keep everyone as safe as possible throughout the county.

The Autism and Special Needs Registry is designed to assist police and fire departments during encounters with members of the community who have disabilities such as, but not limited to, Alzheimer's, Autism, Schizophrenia, Dementia, or any other mental/developmental disorders.  The goal of this program is to give emergency personnel quick access to critical information about a registered individual with special needs in an emergency situation.  Walworth County will take all possible measures to assure this information is relayed to the proper personnel; however, completion of this form does not guarantee that this information will be readily accessible and shared with responding personnel.   

To enroll in the program, complete the form here, which provides pertinent information about the special needs individual that is entered into our public safety database.  Once the form is completed, the form can be mailed to the address listed on the form.  NOTE:  All questions contained in this form are confidential and will only be used to improve the interaction between the listed person and public safety responders, such as law enforcement, fire, emergency medical care providers and if applicable, school officials.   

By submitting the form, you are consenting to provide this health and medical condition information, which may be shared with the above mentioned personnel, to assist them in responding to an emergency situation.  This information is not shared with the general public.    

To enroll in the program:

  • Read Agreement listed above 
  • Open Registry form 
  • Complete form 
  • Print completed form 
  • Mail form to address listed on the top of the form