Portland Police Bureau


A voluntary registry for people with developmental, mental health, or physical disabilities
who may have difficulty communicating their needs to an officer because of an acute
crisis or a continuing disability. The Disability Accommodation Registry has been a
Portland Police Bureau program since 1996.

The Disability Accommodation Registry (DAR) 
Who can register 
Individuals with mental health, developmental/intellectual disabilities, or physical disabilities or their court-appointed
legal guardian, may register for the program: 
• If you have a disability and you are your own guardian. If you feel there are times when you may be unable 
to tell a police officer about your disability or needs, you are encouraged to register. 
• Court appointed legal guardians can register individuals if documentation is provided. 
• Parents can register minor children who are eligible for the program. 

Why register 
By participating in the DAR program, you are sharing important information with law enforcement that can 
enable them to better assist you or someone you are responsible for. Here are two examples where DAR 
information is extremely helpful: 
• If a DAR participant gets lost in the community, the officer can use the emergency contact information to 
locate the participant’s support system. 
• If a DAR participant is in a crisis situation, the officer can get more information about their particular needs. 

How to register 
To register yourself: 
• Fill out the attached form completely. 
• You will need a contact person (family member, caseworker, caregiver, provider, doctor or other person) to fill out the
Emergency Contact Information on page 4. 
• You will need someone-a witness- to fill out the Witness Contact Information on page 4 and sign the form as your
Informed consent. This means you and the person signing the informed consent as a witness understand you are
voluntarily giving this information to the police and want the police to have access to this information. The witness
may also be your Emergency Contact person.
To register someone if you are their court-appointed guardian: 
• Fill out the attached form completely. 
• Attach a certified copy of the guardianship papers to the completed DAR form. Guardianship papers 
must be sent in each year, even if the person has been registered in the past. Parents registering minor 
children do not need to send proof of guardianship. 
• You will need to sign on the guardian signature line. No witness signature is necessary with guardian 

How frequently do you have to register 
Registrations are updated annually. A new form must be completed every year in order to continue as a 
participant in the DAR. A reminder letter and new form are sent to registrants each year. You may withdraw 
from the registry or change your information at any time. 

Can you still be arrested if you register with the DAR 
Registration in the program will not prevent anyone from being arrested if a crime has been committed. 
However, DAR information allows police and jail personnel access to pertinent information regarding the 
registrant’s special needs. 

How information is used 
DAR information is entered into the Portland Police Data System. When an officer comes in contact with a 
person who has signed up for the DAR and their name is entered into the officer’s computer system, the name 
comes back noting they are a participant in the DAR and provides the officer with the information you provided 
on the registration form. 
All information in this system is governed by Oregon Public Records law applying to the Portland Police Data 
System. Information will be released to public agencies for public agency purposes. 
Mail completed form to: 
Portland Police Bureau, Disability Accommodation Registry 
Family Services Division 
10225 E. Burnside Street, Portland, OR 97216 
Fax completed form to: 503-823-0078
Questions about the program may be directed to: 
Portland Police Bureau, Family Services Division at: 503-823-0090 

Disability Accommodation Registry Form         Date: ______________________________ 
Registrant Information 
First Name________________________ Last Name________________________  Middle____________________ 
Nickname_____________________________________________________________________ … Male … Female 
Date of Birth ____________Age _______Hair ________Eyes __________Height ___________Weight ________ 
Does the registrant speak English? … Yes … No If no, language spoken: __________________________________ 
Address _____________________________________________________________________________________ 
City ________________________________________________State _____________Zip ____________________ 
Home Phone_________________________________________Other Phone _______________________________ 
List any scars, marks or tattoos ___________________________________________________________________ 
Name of Residence (if applicable) _________________________________________________________________ 
Name of Contact at Residence ____________________________________________________________________ 
Contact’s Phone Number _________________________________________________________________________ 

Describe your disability (pertinent information only): ______________________________________________ 

Check all that apply: 

… Blind or low vision … Deaf or hard of hearing … Non-verbal   … Difficulty communicating 
… Memory loss … Mental illness   … Physical disability … Seizure … Developmental/Intellectual Disability 
… Other: 
Please describe your communication methods and ways officers can best communicate with you: 

Do you take prescription medication for your disability? … Yes … No Please list prescription medications:
Continued on back Î 

Disability Accommodation Registry Form (cont.) 
List any other information an officer should know:


Court-appointed Guardian Information 
Do you have a court-appointed legal guardian? … Yes … No If yes, provide contact information for guardian: 
Name ______________________________________________________________________________________
Address ___________________________________________Telephone ________________________________ 
City ________________________________State __________Zip Code _________________________________
Type of Guardianship ____________________________________________Date_________________________ 
 … Guardianship paperwork attached? 

Emergency Contact Information
Name _____________________________________________________________________________________ 
Address_____________________________________________________Telephone ______________________ 
City____________________________________________ State ________ Zip Code ______________________ 
Other Emergency Contact_______________________________________Telephone______________________ 

Witness Contact Information
Address ____________________________________________________________________________________
Zip Code

The undersigned hereby releases this information to be entered into the Portland Police Data System 
for use by public agencies as governed by Oregon Public Records law. 
Registrant Signature ___________________________________________________ Date___________________ 
Court appointed Guardian Signature ______________________________________  Date___________________ 
Witness Signature ____________________________________________________  Date____________________
Witness Printed Name _________________________________________   Witness Phone #_________________
For Records Division Processing Only 


Rev 10_2012

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