Create a Website Account - Manage notification subscriptions, save form progress and more.
The Special Needs Information Program (SNIP) is designed to help emergency responders identify and respond to vulnerable residents with special needs. This is a voluntary program in which special needs community members of any age, or their family members, submit information like triggers, special accommodations, emergency contacts, and a photograph.
Please fill out this form to the best of your ability and attach at least one photograph.
If you need assistance filling out this form please call the Hanover Communications Center at 603-643-2222.
If you would like us to call you by a different name than your legal name.
WORK, SCHOOL, OR OTHER FREQUENTED LOCATION
FEET AND INCHES
Please select any or all relevant diagnoses. You are not required to have a formal diagnosis.
It is common for all people to experience one or more of these responses when under extreme stress. If you know how you respond under these situations, please select the best option(s).
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
By signing here I give permission for the staff of SNSC to share and exchange information in this form with the staffs of the Hanover, Hartford, and Lebanon dispatch centers and their First Responders for the purpose of providing assistance to me, or in the case of a minor or adult in guardianship, the person that I am registering.
This field is not part of the form submission.
* indicates a required field