Government » Elected Officials » Sheriff's Office » Divisions » BCI

Vital ID Program Form

Font Size: + -
Share & Bookmark, Press Enter to show all options, press Tab go to next option
Print

This form should only be submitted AFTER an appointment has been confirmed by the Somerset County BCI Unit via email or phone call.

Please correct the fields below:

VIP resizemedicalIDSecureKidsID
Child/Individual Information:
 *
Child/Individual Information:
Additional Information:
Additional Information:
Do you wear glasses?
Do you wear glasses?
Parent/Guardian Information
Parent/Guardian Information

If you have chosen a Medical ID, also fill out the following information:

Health Information
Health Information
Emergency Contacts
Emergency Contacts
Medical Team
Medical Team
Medication, (in order of importance)
Medication, (in order of importance)
**If Parent/Guardian is present – options include an ID Card for the child and an APP download or Thumb Drive. If no parent will be present, the child will be given an ID Card and/or the Print-Out of detailed fingerprints and information.  
Consent: I give my consent for the above-named minor to participate in the Vital ID Program using the information I have provided. I understand that none of the provided information will be retained by the agency, and that all materials will be given to the child prior to permanent deletion.  Entering a name constitutes an electronic signature. I request: (CHECK what applies – APP Download requires guardian device):
 *
Consent: I give my consent for the above-named minor to participate in the Vital ID Program using the information I have provided. I understand that none of the provided information will be retained by the agency, and that all materials will be given to the child prior to permanent deletion. Entering a name constitutes an electronic signature. I request: (CHECK what applies – APP Download requires guardian device):
 
 *
  1. To receive a copy of your submission, please fill out your email address below and submit.