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2. To the Parent or Guardian: The Mission of Project Guardian is to develop partnerships between Law Enforcement Officers, community agencies, and members of our community with autism. This program trains officers on the fundamentals of autism and how to better respond to calls for service involving individuals with autism, and establishes a voluntary database of information provided by families to assist officers prior to arrival on a call for service. Project Guardian is wholly voluntary, and you may request withdrawal at any time.
4. Individual's name*
6. Date of birth*
8. Race*
10. Eye color*
12. Hair color*
14. Height*
16. Weight*
18. Tracking device transmitter number
    if applicable
20. Individual's address*
22. Recent photo of individual
24. Parent or guardian name(s)*
26. Contact phone numbers*
28. Individual's diagnosis
30. Emergency contact information*
    If parent/guardian cannot be reached.
32. List any atypical behaviors
    e.g. self-talk, hand flapping, spitting
34. List any medical or health issues
36. Special interests
38. De-escalation techniques
    e.g. counting, breathing, squeezing hands, deep pressure
40. Additional information
42. The City of Newport News respects your right to privacy. To the extent permitted by law, the Newport News Police Department will strive to ensure that the information provided is disseminated only for the purposes stated herein. However, this form constitutes a public record subject to the provisions and exclusions of the Virginia Freedom of Information Act.
44. I certify that I am the parent or legal guardian of the individual listed on this form, and have legal authority to sign this document. I understand that submitting this information is strictly voluntary, and consent to its entry into the Newport News Police Department records management system. I understand and agree that it is my responsibility to keep this information current. I understand and agree that the Newport News Police Department will provide this information to officers responding to a call for service at the stated address. I understand that this information may be released to other first-responder agencies, such as the Newport News Fire Department, responding to calls for service at this address, and consent to such dissemination. I waive and release the City of Newport News and its officials, officers, employees, and agents from any and all claims arising out of the release of information provided in this form.
Leave This Blank:


46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit

* indicates a required field