Niskayuna Vulnerable Person Registry
Please complete the following form with the vulnerable person's information. You will be asked for Emergency Contact information on the next page. 
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First Name *
Last Name *
Date of Birth *
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Gender *
Race
*
Ethnicity
 *
Hair Color
 *
Eye Color *
Height *
Weight *
Address *
Phone Number *
Organization(s) the vulnerable individual is associated with:
Identifying features (scars/marks/tattoos):
Special Instructions 
Please include any known triggers and/or methods to deescalate the vulnerable individual:
Details of any cell phone, GPS enabled devices or Project Lifesaver the individual uses:
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