Child with Special Needs - Please Help Me
My name is _________________________________________________________ and I have special needs.
I may or may not speak. I do not always understand danger. I become lost easily and do not know that I am lost.
I may have outbursts involving self-harm in unusual ways. I do this particularly when I am stressed. However, I am not
dangerous. I do not have the intent to harm anyone. Please help me.
My parents/guardians are:
My address is:
My parent’s/guardian’s phone number is:
My other emergency contact is:
Their contact number is:
If you found me in a store or other building with a public address system, please have someone call my caregiver or
secondary emergency contact over the system. If they cannot be located, please call the police. Don’t leave me
alone or let me wander off!
A downloadable version of this template can be found at awsfoundation.org
Source: http://hasselbrink.com/Pocketslip2a.pdf
Form AWSF SK03
Child with Special Needs - Please Help Me
My name is _________________________________________________________ and I have special needs.
I may or may not speak. I do not always understand danger. I become lost easily and do not know that I am lost.
I may have outbursts involving self-harm in unusual ways. I do this particularly when I am stressed. However, I am not
dangerous. I do not have the intent to harm anyone. Please help me.
My parents/guardians are:
My address is:
My parent’s/guardian’s phone number is:
My other emergency contact is:
Their contact number is:
If you found me in a store or other building with a public address system, please have someone call my caregiver or
secondary emergency contact over the system. If they cannot be located, please call the police. Don’t leave me
alone or let me wander off!
A downloadable version of this template can be found at awsfoundation.org
Source: http://hasselbrink.com/Pocketslip2a.pdf
Form AWSF SK03