Prairie Grove, IL · McHenry County
Premise Alert Program Notification Form
This form lets an individual or someone familiar with them share special-needs information with Prairie Grove police for emergency responders.
What this form is
The form lets an individual, family member, friend, caregiver, or medical professional provide information for the Premise Alert Program database used by emergency responders. It asks about the individual’s needs and precautions, plus contact information and verification. Use it to add, change, renew, or remove information; the notification expires two years after submission.
Who needs it
Individuals with special needs, or someone familiar with them, can submit this form to help inform emergency responders.
How to submit it
Forward the completed form to the Prairie Grove Police Department, 3121 Barreville Road, Prairie Grove, IL 60012, or fax it to 815.455.5694.
About notarization
This document is signed and dated without a notary; the signer verifies the information and gives permission for its entry into the program database.
How to submit this form
- 1
Download The Form
Download the Premise Alert Program Notification Form.
- 2
Complete The Form
Print legibly and provide the individual’s special-needs information, precautions, and contact details.
- 3
Sign And Date
Sign and date the form to verify the information and give permission for database entry.
- 4
Submit To The Police Department
Send or fax the completed form to the Prairie Grove Police Department using the address or fax number listed.
Frequently asked questions
- What is the Premise Alert Program form for?
- It provides information about a special-needs individual for a database available to emergency responders. The form can add, change, renew, or remove information.
- Who can provide information on the form?
- The individual, a family member, friend, caregiver, or medical personnel familiar with the individual may provide and verify the information.
- Do I need a notary for the Premise Alert Program form?
- No. The form is signed and dated without a notary; the signer verifies the information and gives permission for its entry into the program database.
- How do I submit the Premise Alert Program form?
- Send the completed form to the Prairie Grove Police Department at 3121 Barreville Road, Prairie Grove, IL 60012, or fax it to 815.455.5694.
Need something notarized?
This Premise Alert Program Notification Form doesn’t need a notary — but Illinois residents can notarize other documents online with a commissioned online notary.