Madison County Sheriff’s Office PIN Sticker Program Participant Registration Form

You can fill out and submit the form below to receive a sticker.

The form will be emailed to Capt. Kris Tharp.

Madison County Sheriff’s Department
405 Randle St., Edwardsville
618-692-4433

St. John’s Community Care will not collect any personal information or solicit anyone who inquires about a the P.I.N. Sticker Program. This is a free program and is voluntary for anyone who feels it would benefit their family or loved one living with Alzheimer’s/Dementia / Autism / Epilepsy / Diabetic / Vision Impaired / Service Animal / Hearing Impaired / Other/Not Listed.

To learn more read or watch more about the program here –

Madison County Sheriff’s program aids residents with communication barriers (theintelligencer.com)

Madison County sticker program underway for residents with communication barriers (fox2now.com)

P.I.N. Sticker Form

* Required

"*" indicates required fields

Martial Status:
Medic Alert:
Hearing Impaired: