911Ready Bag Police, Fire & Rescue and EMS Department Participation Request

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This form is to be completed by Police, Fire and Rescue and Emergency Medical Services Departments that would like to be contacted to participate in the 911Ready Bag Program. Both the 911Ready Program (launching by Fall of 2021 for select test cities) and the 911Ready Bag Program are divisions of Mimi's Mission, a 501c3 Non-Profit organization that helps Downriver families with autistic children. For full description of the 911Ready Bag Program, please visit mimismission.org.

Please select department type: *

Fire & Rescue

Police

Emergency Medical Services

Other:

What city or township are you contacting us about? *

County in Michigan *

Station, Company or Department Name *

City *

Zip Code *

Please list the area you service (ex. city or cities) *

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