Persons With Autism - Police Assistance Registry

What is the Autism Registry?

The Autism Registry is a Midland Police Service program that promotes communication and gives police quick access to critical information about a registered person on the Autism Spectrum. The Autism Registry can provide police with emergency contact information, detailed physical descriptions, known routines, favourite attractions or special needs of the individual on the Autism Spectrum. This information can assist officers in communicating with, attending a residence of or dealing with an emergency involving an individual with ASD.

How it Works:

The Autism Registry is accessible to those residents who reside within the Town of Midland or who have children who go to school or attend activities in Midland. Fill out the online form below or attend the Midland Police Service, 250 Second St. for a paper copy to fill out.

When complete, review and submit the report.

Once submitted and we have reviewed it, you will receive a confirmation email that provides a confirmation that the submission is approved and provides a permanent Occurrence Number and provides the option to attach a picture to the form by replying to the confirmation email once approved.

Register annually:

Annual registration is required to keep your form active. It is the responsibility of the applicant to resubmit the form. It is recommended that you resubmit on the registrant’s birthday to make it easier to remember.

Please consult our Frequently Asked Questions document for more information about this registry.

Contacts:

PC Aaron Coulter #65
Community Services Officer
Midland Police Service
250 Second St. Midland ON L4R 4K6
65@police.midland.on.ca
(705) 526 2201


Midland Police Service Autism Registry
Person With Autism - Information

Family name of child/adult with autism

Any name other than the Given name above that the person is more likely to respond to

Primary Residence

A primary physical address (9-1-1 address) where the person described above lives (no lot/plan numbers or PO boxes)

FT-IN
LBS

Does this person wear eyeglasses or other corrective lenses?

Please describe any scars on this person's body, including those from accidents, misadventure, medical procedures and self harm. We need approximate size (length or dimensions) and location on body for each.

Please describe any birthmarks or other marks on this person's body. We need approximate size (length or dimensions), color and location on body for each.

Please describe any tattoos on this person's body. We need approximate size (length or dimensions), color(s), description of the image/text/pattern and location on body for each.

Please describe any identification worn or likely in their possession and where they likely keep it.

Please describe any inclination for wandering or characteristics that may attract this person's attention

Please describe any favourite attractions and locations where this person may be drawn to and likely found

Please describe any best methods of approach for this person, including any de-escalation techniques that you find most productive.

Please describe any life-threatening medical concerns that relate to this person

Please describe any other relevant information here including details about any selections that you made above that refer to adding details in the comment section. You may also want to share information about this person's favourite toys, names that are most likely to generate positive responses. Also include any reinforcers that are used, suggestions for de-esclation and/or cooperation (ie: likes to hold pens)

Are there any actions / interactions that are likely to discourage co-operation and make it more difficult to interact with this person or gain their compliance with our requests or attempts to de-escalate a situation? Your input here is VERY important.

Emergency Contact Information
Primary Contact

What is your relationship to the person registered above (parent, guardian etc)

If different from person with autism listed above

Alternate Contact

What is your relationship to the person registered above (parent, guardian etc)

If different from person with autism listed above

Registrant Information

TERMS OF USE: Through this form, the Midland Police Service (MPS) will collect information that can identify you or a family member. Such identifying information may include your name, date of birth, e-mail, address, mailing address and other similar information (“personal data”) when it is voluntarily submitted under Sec 29(1)(a) MFIPPA.

The MPS will use your personal data to respond to request you make of us and/or interacting with the persons named. From time to time, we may refer to your personal data to better understand your needs and how we can improve our services in relation to you and / or your family. This information may be be accessed by other Police Agencies through the Police Information Portal however consent must be provided for the use of such information.

It is acknowledged that it is your responsibility to ensure that the information so collected is current and valid, and that the MPS is notified in writing of any changes.

The retention, as well as any other use or disclosure, of the information will be dictated by the requirements under the Municipal Freedom of Information and Protection of Privacy Act, R.S.O. 1990, c. M.56.

By clicking Agree, you accept the terms under which you are supplying this information to the Midland Police Service as stated above.

What is your relationship to the person registered above (parent, guardian etc)

If different from person with autism listed above

CAPTCHA
This question is for testing whether you are a human visitor and to prevent automated spam submissions.
Image CAPTCHA
Copy the characters (respecting upper/lower case) from the image.