Project Safe Return Registration
Project Safe Return Registration
Project Safe Return Registration The goal of Project Safe Return is to aid first responders in search and rescue operations for at-risk individuals with cognitive and/or behavioral disorders, who may be prone to wandering and/or getting lost. The information requested in this application is critical in the event the at-risk individual becomes lost. Additionally, providing this information in advance allows first responders to identify at-risk individuals who may be located before being reported missing. In an effort to keep our records up to date, we request you log in at least once every six months and check the accuracy of the information in the Participant's file and replace older photos with new ones. Please be sure to complete all fields on the application. Required fields are indicated by a * symbol. On submit, invalid input fields may be additionally marked to indicate that the user still needs to enter a value. By submitting this application, you certify that you are the legal caregiver/legal guardian of this Participant and are authorized to provide the information contained in this application. The registration form collects the following information: Person Providing Information: First Name, Last Name, Phone Number, E-mail address At-Risk Individual (Participant) Personal Information: First Name, Middle Initial, Last Name, Nickname, Date of Birth, Address, City, State, Zip, Type of Address (House, Apartment, Nursing Home, ALF), Race, Sex, Hair Color, Eye Color, Height and Weight, Distinguishing Features (Scars/Marks/Tattoos), Known Physical Disabilities, Known Calming Techniques, Suggested Ways to Communicate/Interact with Participant, History of wandering away/getting lost, Places participant likes to go Participant Photos: Up to three recent photos (taken within last six months, high resolution, under 10MB each) Medical/Miscellaneous Information: Medical conditions (Autistic, Dementia, Alzheimer's, Blind, Deaf, etc.), English language proficiency, first language if applicable, tracking devices (Scent Kit, Tracker, Bracelet/Necklace) Doctor Information: Doctor's Name and Phone Number Emergency Contact #1 (required): First Name, Middle Initial, Last Name, Address, City, State, Zip, Phone Number, Alt Phone Number, E-mail address, Relation to Participant Emergency Contact #2 (optional): First Name, Middle Initial, Last Name, Address, City, State, Zip, Phone Number, Alt Phone Number, E-mail address, Relation to Participant
