Form Center

By signing in or creating an account, some fields will auto-populate with your information.

Special Needs Alert Program (SNAP)

  1. Winters PD Badge702 Main Street
    Winters, CA 95694
    Dispatch 530-795-4561 | Officer 530-795-2261
    Fax 530-795-3921

  2. (used for annual update reminders)

  3. Emergency Contact Information
  4. Special Needs: please check all that apply*
  5. Special Considerations: please check all that apply
  6. Program Information

    By submitting this information you affirm the following: I understand the information I provide about health and/or medical conditions may be shared with Police, Fire, and other emergency responders to assist them in responding to an emergency or disaster. I understand providing this information does not insure that emergency responders will be able to provide services in an emergency, but will assist them in responding appropriately based on available resources. I understand I may revoke consent to sharing information/enrollment in SNAP at any time by sending a written request to: Winters Police Department Attn: SNAP 702 Main St Winters, CA 95694. I certify the information provided on this form is true and correct. I acknowledge it is my responsibility to update the information on this form as 

  7. Electronic Signature Agreement
    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.
  8. Leave This Blank:

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