Mequon Police Department Mequon Cares Application

Please fill out and submit to participate in the program. Questions with an asterisk are mandatory.
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1. What is your name, address, and phone number?
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2. What is your doctor's name and phone number?
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3. What is your clergy's name and phone number?
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4. Are you taking medications? Yes/ No If yes, what type?
5. What are the names and phone numbers for your emergency contacts?
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