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Special Needs Registry - Registration Form

  1. Intro
    NOTICE BY SUBMITTING THIS FORM YOU AFFIRM UNDER OATH THAT YOU ARE LEGALLY RESPONSIBLE FOR THE PERSON NAMED BELOW FOR WHOM YOU HAVE PROVIDED INFORMATION AND THAT YOU CONSENT TO HAVE THIS INFORMATION SHARED AMONG LAW ENFORCEMENT PERSONNEL FOR ENROLLMENT IN MAHONING COUNTY’S SPECIAL NEEDS REGISTRY. PLEASE KEEP A COPY OF THIS FORM FOR YOUR RECORDS.
  2. PLEASE CONTACT US ANNUALLY TO UPDATE THE PICTURE AND IF ANY INFORMATION CHANGES. IF YOU HAVE ANY QUESTIONS, PLEASE SUBMIT THEM AT [email protected].
  3. Personal Information
  4. Glasess
  5. Disability
  6. Method of Communication
  7. Does the registrant own a motor vehicle?
  8. Emergency Contact Information - First
  9. Emergency Contact Information - Alternate
  10. Leave This Blank:

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