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Special Needs Alert Program (S.N.A.P.)

  1. Special Needs Alert Program (S.N.A.P.)

    The Special Needs Alert Program (SNAP) is designed to ensure the safety of those residents of the City of Woodland that are most vulnerable to emergencies and disasters, the elderly and infirmed and those with various disabilities and special needs. The information you provide about health and medical conditions may be shared with Police, Fire and other emergency responders to assist them in responding to an emergency or disaster.

  2. Alert Options*
  3. Please make sure the photograph is only of the registering person (portraits are best). The photograph needs to be of clear quality, recent and preferably in color.
  4. This email address will be used for annual update alert reminders.
  5. Registrant Information
  6. Emergency Contact Information
  7. Special Needs*
    Please select all that apply:
  8. Special Considerations*
    Please check all that apply:
  9. Disclaimer*
    You may revoke your consent to sharing information at any time by written request to: The Woodland Police Department, 1000 Lincoln Ave., Woodland, CA 95695 (ATTN: SNAP). "Providing this information does not insure that emergency responders will be able to provide services to you in an emergency but will assist them in responding appropriately based on available resources." Additionally, I give local law enforcement and/or medical personnel permission to enter my home in case of an emergency. By submitting this information, you consent to sharing information on this form. I certify that the information provided on this form is true and correct. It is my responsibility to update the information on this form as needed.
  10. Electronic Signature Agreement*
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date. 4) You are an authorized representative of the individual being registered and/or have the registrant's consent to submit this form on their behalf.
  11. Leave This Blank:

  12. This field is not part of the form submission.