The Illinois Premise Alert Program (Public Act 96-0788) provides for Public Safety Agencies in the State of Illinois to allow people with special needs to provide information to police, fire and EMS personnel to be kept in a database. The information can then be provided to Police/Fire/EMS units responding to the specified locations in dealing with situations involving the Special Needs individuals.

The information provided by you will be kept confidential and used only to provide Police, Fire and EMS personnel responding to specified locations with the information needed to deal with situations or emergencies involving a Special Needs person.

The notification expires and the information will be deleted from the database 2 (two) years after the date it is submitted. You may update or renew it at any time by submitting a new form.