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AUTISM & SPECIAL NEEDS REGISTRY

Please submit this form if you have a loved one with autism and/or special needs who lives in the City of Greenfield, or spends a significant amount of time in the City of Greenfield. We recommend resubmitting this form with updated information annually. Information that has been on file for more than a year will be periodically purged.

Please complete the following as it relates to the person to be added to the Registry

Please upload a current photograph of the person.

Please complete the following as it relates to the person completing this form (Emergency Contact)

Please complete the following is it relates to a secondary Emergency Contact (if applicable)