A program sponsored by
Sheriff Bob Johnson

Because we care 

The SAFE Program is a means for allowing better communication between Santa Rosa County Emergency Responders and residents with special needs, or other disabilities, regarding critical information before an emergency occurs.


About the SAFE program.

The SAFE program is completely voluntary but your information can help save lives. From missing persons to special requirements.  When a Deputy, EMS of Fire see’s the sticker, we know to approach with care. 

For Your Home

First Responders coming to a home will identify the need for special care or communications. Place  one decal near your front door. 

For Your Car

First Responders on a traffic stop, accident or medical emergency will be able to identify the need for special care or communication.  Place one decal on the rear drivers side of your vehicle.

Sheriff-Police-Fire-EMS

This program is known by all Santa Rosa County First Responders. This is the decal first responders will be looking for.

Enrolling is easy!
Just fill out the form below and click the submit button. We will take care of the rest.

SAFE Enrollment Form

SAFE Enrollee's Information

Individual's Name
Individual's Name
First Name
Middle Name
Last Name

Enrollee's Residence and Mailing Address

Enrollee's Physical Description

Male, Female, etc.
Alaska Native, American Indian, Asian, Black or African American, Native Hawaiian, Other Pacific Islander, White, Other

Miscellaneous Information About Enrollee (if applicable)

How does the enrollee communicate? For instance, does the person communicate by means other than speaking such as using sign language, verbal, or nonverbal? Do they speak a language other than English?
Are there things that cause the enrollee to become violent, withrawn, frightened, or otherwise cause an emotional change?
Can Enrollee Swim:

Enrollee's Physical/Mental Diagnosis

Emergency Contact Information

Individual 1
Individual 1
First
Middle
Last
Relationship to Enrollee
Brother, Sister, Aunt, Uncle, etc.
Identification (choose one):
Individual 2:
Individual 2:
First
Middle
Last
Relationship to Enrollee
Brother, Sister, Aunt, Uncle, Foster Parent, etc.
Identification (choose one):

Additional Emergency Contacts

Additional Emergency Contact Name 1
Additional Emergency Contact Name 1
First
Middle
Last
Additional Emergency Contact Name 2
Additional Emergency Contact Name 2
First
Middle
Last

Enrollee's Vehicle Information

Enter information about the enrollee's vehicle or information about the vehicle where the enrollee will be an occupant.

Pictures may be submitted along with completed forms.

Only PNG or JPG file types are accepted. File size must be smaller than 2MB. A 5x6 portrait image is preferred.
Maximum upload size: 2MB
Enter your email address.
Confirm your email address. Entries must match.

Resources

Enrollment Form

Here you can download the SAFE enrollment form. Fill Complete the enrollment form on your computer or print it and submit. Don’t forget a recent photo. Completed forms can still be emailed to [email protected]

Download Here

Community Flyer

Share the downloadable flyer with friends and family. The more people that are SAFE the better!

Download Here

Update Enrollment

Have a loved one currently enrolled in SAFE and need to make some changes? Click the link below to update.

Update Here