What is a Disability Registration Form

Emergencies can happen at any time and require an immediate response. At the time of an emergency, first responders including police, fire and emergency medical personnel need essential information about the individual involved as quickly as possible. This information can include the person’s physical characteristics, patterns of behavior, disability, and emergency contact information.

When a Disability Registration Form is on file with your local first responders prior to an emergency, the information is easily accessible within minutes of an emergency call. Emergency dispatchers can then provide the information to all personnel involved with the emergency situation so they can provide an individualized response.

Type of Disability Registration Forms

There are two types of forms in Massachusetts.

Statewide Form

The MA 911 Disability Indicator Form is available to anyone in Massachusetts that may require additional assistance during an emergency. Once it is submitted to your emergency response center, and a 911 call is made from your landline, wireless phone or VoIP system, the emergency dispatcher will see the disability indicator code and inform first responders.

For example, if you are at a restaurant in Massachusetts (your home community or any other location) and you call 911 from your cell phone, the disability indicator will show on the dispatcher’s call screen. The dispatcher will ask if the emergency involves the person with special needs or not.

The person with a disability, or anyone (family members, caregivers, friends, etc) who spends time with the person needing special assistance during an emergency can submit a MA 911 Disability Indicator Form with their landline and/or wireless phone number. The form has all of the instructions on how to submit the form to your emergency disputer center.

Mass 911 Disability Indicator Form

Registry for households with a landline. When you call 9-1-1 from your landline your local dispatcher will immediately see the disability indicator code. This registry should be completed in addition to a more detailed form offered by some cities and towns.

Community Specific Forms

In addition to the statewide form, many communities currently have a form on their police department website. Common names for disability forms are SafeWatch, Disability Alert, Smart 911, Impairment or Elopement Risk form. Residents can download and complete the form and return it to the police department. Some departments encourage people to make an appointment when you return the form so they can meet you and the person you are registering. This is a great opportunity to speak to emergency personnel in a relaxing setting instead of during a time of high anxiety or crisis.

Click on the name of your city or town below to see if there is a community specific form available. If one Is available, follow the link to print the form and report whatever information you want to share with first responders. If your community does not currently have a Disability Registration Form on their website, make an appointment with a police department representative and share the sample form available here.

Amesbury

Not Available.

Andover

Elopement Risk Form

Boxford

Not Available.

Georgetown

Not Available.

Groveland

Not Available.

Haverhill

SafeWatch/Return Home Form

Lawrence

Safe Watch Form (English)

Lawrence - Spanish

Safe Watch (Spanish)

Merrimac

Disability Registration Form

Methuen

SMART 9-1-1 registration and Methuen’s Disability Alert Form

Newbury

Not Available.

Newburyport

Not Available.

North Andover

SMART 9-1-1 registration

Rowley

Not Available

Salisbury

Not Available.

West Newbury

Not Available.

Other safety resources

Safety is a multi-faceted challenge for many individuals with a disability. Registering an at-risk loved one with a local authority is only a small part of building a framework that keeps them safe while affording opportunities for independence, choice-making and self-advocacy. Here’s a list of additional resources that may benefit your individual. If you’re interested in learning more or joining our effort, let’s get connected.

About The Disability Registration Form Project

A group of parents of children and adults with disabilities in the Merrimack Valley (Massachusetts) saw the importance of providing first responders with accurate information about our loved one before an emergency happened. Many of us have personally experienced first responder interactions with our loved ones, both successful and those that could be improved by timely access to information on file.We researched the type of information that would be important and met with first responders to discuss how they could collect information from people with disabilities in their community. This website is meant to connect individuals and families in the Merrimack Valley to the disability resources available in Massachusetts and in their own community.