Disability Forms and Registration

The Henderson Police Department in coordination with the Justin Hope Foundation has Developmental Disability forms and registration available for all City of Henderson residents.

This is a voluntary registration for children and adults affected by a developmental disability who reside in the City of Henderson.

The submission of the form will equip Henderson Police Officers with much needed information before responding to a residence with an involved individual.

Examples of Developmental Disability Items

A small example of what qualifies as a Developmental Disability item are as follows:

• Autism
• Fetal Alcohol Syndrome
• Down Syndrome
• Cerebral Palsy
• Tourette’s Syndrome
• Deafness
• Visual impairments
• All developmental Disabilities qualify for this voluntary application

Application Forms

Examples

A small example of what is on the application form are as follows:

• Emergency contact information
• Description of individual
• Allergies
• Wandering habits
• Sensory issues
• Level of functionality
• Responds to name
• Responds to touch

This form is not a registration for Mental illness diagnosis’s (PTSD, Schizophrenia)

Forms

Again, please note: This form is for anyone who resides within the City of Henderson only, and registration is completely voluntary.

• Developmental Disability Form - English
• Developmental Disability Form - Spanish

These forms are available at all Henderson Police Department stations, and our patrol officers will also have them on hand to provide our community members.

Contact

Please complete the form and submit it, or any questions you may have regarding the program, to Officer M. Coleman at DDregistration@cityofhenderson.com.

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