Project Safe Return Registration

Project Safe Return, a program offered by Hernando County Sheriff's Office

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 with Invalid input indicator: an exclamation mark inside of a circle 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.

Person Providing Information

First Name

Please enter a first name

Last Name

Please enter a last name

Phone Number

Please enter a complete phone number

E-mail address

Please enter an email address

At-Risk Individual (Participant) Personal Information

First Name

Please enter a first name

Middle Initial

Last Name

Please enter a last name

Nickname

Date Of Birth (mm/dd/yyyy)

Please enter a date of birth

Address

Please provide an Address

City

Please provide a city

State

Please provide a state

Zip

Please provide a zip

Type of Address

House

Apartment

Nursing Home

ALF

Please select a value

Race

Please select a value

Sex

Please select a value

Hair Color

Please select a value

Eye Color

Please select a value

Height and Weight

Feet

Please enter the feet part of the height

Inches

Please enter the inches part of the height

Weight (in Lbs)

Please enter the participant weight

Distinguishing Features (Scars/Marks/Tattoos)

Known Physical Disabilities:

Known Calming Techniques:

Suggested Ways to Communicate/Interact with Participant:

Has the Participant ever wandered away/gotten lost before?

Yes

No

Please select a value

If the Participant has wandered away/gotten lost before, please explain:

Please enter an explanation

Is there a place(s) the Participant likes to go or that we should check first?

Participant Photos

Please upload at least one, and up to three, recent photos of the participant. Photos should be high resolution and taken within last six months. Each file must be under 10MB in size. A photo is necessary to be able to identify the participant.

Choose up to 3 photos, under 10MB.

Please upload an image

Medical/Miscellaneous Information

Please tell us anything we need to know about the Participant (Autistic, Dementia, Alzheimer's, Blind, Deaf, ETC):

Does the Participant Speak English?

Yes

No

Please select a value

If not, what is the Participant’s first language?

Please specify a language

Please indicate if the Participant has any of the following:

Scent Kit

Tracker

Bracelet/Necklace

Doctor Information

Doctor's Name

Doctor's Phone Number

Emergency Contact #1

First Name

Please enter a first name

Middle Initial

Last Name

Please enter a last name

Address

Please provide an Address

City

Please provide a city

State

Please provide a valid state

Zip

Please provide a valid zip

Phone Number

Please enter a complete phone number

Alt Phone Number

E-mail address

Please enter an email address

Relation to Participant

Please specify the contact's relationship to the participant

Emergency Contact #2

First Name

Middle Initial

Last Name

Address

City

State

Zip

Phone Number

Alt Phone Number

E-mail address

Relation to Participant

Project Safe Return Registration Form

Person Providing Information

At-Risk Individual (Participant) Personal Information

Participant Photos

Medical/Miscellaneous Information

Doctor Information

Emergency Contact #1

Emergency Contact #2