Evanston Police, Fire & Life Safety Premise Alert Program Notification Form

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 responders dealing with situations involving the Special Needs individuals.

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

The notification expires 2 (two) years after the date it was submitted. You may update or renew it at any time by filing the digital form. If you are unable to submit the form digitally, please return the completed form to:

Evanston Police Department Communications Bureau 
1454 Elmwood Avenue 
Evanston, IL 60201-4360

The data is provided by the individual or other person in order to provide responding Police, Fire or EMS personnel information to provide emergency services. The information will be entered into databases maintained by the Police and Fire Departments and may be shared with other police, fire or EMS agencies as needed to provide services to the individual.

The individuals must understand that the information provided here will not result in any type of preferential treatment to the individual and that the City of Evanston, its police and fire departments nor any other responding agencies will not be held liable for duties relating to the reporting of special needs individuals. I also understand that if any of the above information changes I must notify the Evanston Police Department by filing an amended request form. The information will self expire 2 (two) years from the date received by the Police Department and I must renew the form if I want the information kept in the Police and Fire Databases.

I understand and agree to these terms: