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NAS Rotherham Branch

Autism Alert Card

Application Form

The Autism Alert Card is a card that enables those that carry it to identify themselves to workers in emergency services as having an Autism Spectrum Disorder (This includes Autism and Asperger syndrome). It has been designed by The National Autistic Society in Yorkshire with South Yorkshire Police to be recognised by their officers but can be used to show personnel from other emergency services such as fire officers and ambulance staff. You may also find it useful to show to hospital staff or in other situations where you want inform public service staff about your autism.

 

The card provides an opportunity for personnel presented with a card to contact a named representative of the individual on the autism spectrum in order that they can gain a full understanding of their needs. If the 2 named representatives are not available then the staff member may contact the NAS Contact details on the card for further information.

 

In order for this information to be correctly controlled it is necessary for the person who will be carrying the card (the card bearer) to have completed the information below. This information will then be stored in a secure location at the NAS office in Rotherham and on a password protected computer database. This card will be linked to you only and cannot be used by anyone else.

 

You must think carefully about whom you want your named representatives be. They can be relatives or friends or anyone who knows you well and knows how your Autism affects you. They need to be available for as many hours as possible (i.e. not just 9 to 5) so that they can be contacted in an emergency. You need to ask their permission and try to ensure it’s someone who will be in your life for quite some time. (You don’t want to have to change your personal contact every few months).  If you have any problems completing the form or obtaining proof of diagnosis, please do not hesitate to contact the NAS Rotherham Branch office, phone number overleaf, where staff will be available to help you.

 

If you lose your Alert Card, or if you wish to change your personal contact, please inform us as soon as possible. We will have to charge a fee of £5 for a replacement card

 

By carrying a card you are consenting that anyone who sees this card may:

 

Contact the named individuals on the card

Contact the Autism Helpline where they will receive general information on Autism

Spectrum Disorders. (This information will not be specific to you and your autism )

Find further information on www.autism.org.uk

 

To apply for an autism alert card please click on the button below to download an application form and email it back to nasrotherhambranch@nas.org.uk