Project Safe Return Registration Form

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.

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 Infomation
At-Risk Individual (Participant) Personal Information
Height:
Weight:
Has the Participant ever wandered away/gotten lost before?
If yes, please explain:
Is there a place(s) the Participant likes to go or that we should check first?
Please provide a valid Address.
Please provide a valid city.
Please provide a valid state.
Please provide a valid zip.
Type of Address:
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.
Choose Photos
Medical/Miscellaneous Information
Please tell us anything we need to know about the Participant:
Does the Participant Speak English?
If no, what is the Participant’s first language?
Please indicate if the Participant has any of the following:
Doctor Information
Emergency Contact #1
Please provide a valid Address.
Please provide a valid city.
Please provide a valid state.
Please provide a valid zip.
Emergency Contact #2
Please provide a valid Address.
Please provide a valid city.
Please provide a valid state.
Please provide a valid zip.