L.O.C.A.T.E.

Law Officers Concerned About the Endangered

L.O.C.A.T.E. empowers our officers with the tools to respond to the needs of our community. The main concept of this program is to gather information to better serve those in our Township with special needs who may require police services.

Is L.O.C.A.T.E. right for you? You may want to consider participation if your loved one may be unable to provide personal information in an emergency. This program helps officers provide effective police services to endangered residents and frequent visitors to Towamencin who may have decreased cognitive function due to Alzheimer's, Dementia, Autism, or Traumatic Brain Injury.

If you feel this program is right for you, please complete the registration form below. Once completed, we ask that you submit a photograph of the person you're registering to 59detectives@towamencinpd.org. This information will be entered into our records management system so it is easily accessible to our officers in the event of an emergency.

Participation in this program is 100% voluntary. Information collected is not disseminated outside of law enforcement or other emergency response agencies. You may withdraw your participation in the program at any time for any reason by emailing 59detectives@towamencinpd.org.

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* 1. What is the first and last name of the person you want to register with L.O.C.A.T.E.?

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* 2. What is their date of birth? (MM/DD/YYYY)

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* 3. What is their address?

Address *

Facility (if applicable)

City/Town *

State/Province *

ZIP/Postal Code *

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* 4. Please provide the following physical descriptors:

Gender:

Race:

Height:

Weight:

Eye color:

Hair Color:

Scars/Marks/Tattoos/Identifying Features:

Significant Medical/Psychological Condition(s):

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* 5. Do they carry or wear jewelry, tags, identification cards? If yes, please describe.

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* 6. Are there any sensory or dietary concerns? If yes, please describe.

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* 7. Are they likely to wander off or run away?

Yes

Unknown

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* 8. If they are likely to wander off or run away, where are some of the places they like to or try to visit?

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* 9. Do they have any behaviors or characteristics that may attract attention? If yes, please describe.

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* 10. Do they respond to any calming or de-escalating techniques? If yes, please describe.

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* 11. If they are non-verbal, what type of communication is their preferred method?

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* 12. Is there any additional information you feel would be helpful in the event of an emergency?

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* 13. What is the contact information for the primary emergency contact?

Name *

Relationship

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

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* 14. If there is a secondary emergency contact, please put their information below:

Name

Relationship

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 15. Your participation in this program means you are the primary caregiver or an emergency contact for a person with care needs.

I understand.

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* 16. Your participation in this program is 100% voluntary, and your consent to participate can be withdrawn at any time by emailing 59detectives@towamencinpd.org.

I understand.

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* 17. By providing your information, you are consenting to participate in the Smart911 system which disseminates information in this registration form to police officers in the event of an emergency.

I understand.

100% of survey complete.