At Risk Registration Program Logo

BCPD’S AT RISK REGISTRATION PROGRAM

Caring for a family member suffering from certain physical and/or medical disabilities presents our community members a challenge. When these individuals also have an increased susceptibility to wandering and/or becoming lost, this challenge becomes even greater.

The City of Burlington Police Department seeks to provide assistance to and ease the burden of our community members providing care to family, friends, and acquaintances suffering from physical and/or medical disabilities that increase their susceptibility to wandering off and/or becoming lost through the At Risk Registration Program.

Program participants will simply provide biographical and background information on an individual deemed susceptible to wandering and/or becoming lost (to include a digital photograph). This information will be confidential maintained in database accessible to police and other first responders and will be used in the provision of services and location efforts only. Should an individual be found wandering or reported missing, the information provided can be accessed to assist with identification and a speedy safe return.

In the event someone you care for wanders off or becomes lost, contact the police immediately and inform the call taker that the person is registered with City of Burlington Police Department’s At Risk Registration Program. The police will then be able to refer to the information already provided. The information on file can be quickly distributed to all officers on duty and a search started. Having the most current and detailed information on file saves time, greatly increases the opportunity for a safe return, and allows for the provision of immediate medical attention if required.

 

If you wish to participate in the City of Burlington Police Department’s At Risk Registration Program, please fill out the form below completely.

 

_________________________________________________________________

PERSON BEING REGISTERED (Required)

Registrant's Name:

Date of Birth:

Social Security:

Address:

Telephone:

Alternate Telephone (optional):

Gender:

Height:

Weight:

Race:

Ethnicity:

Hair Color:

Eye Color:

Build:

Complexion:

Hair Style:

Facial Hair:

Glasses:

Teeth:

Hand:

Blood Type:

Voice Characteristics:

Primary Language:

Scars, Marks, Tattoos:

Description of Medical Conditions:

Participate in Burlington County Sheriff's Office Project Lifesaver?:

Digital Photograph (optional):

_________________________________________________________________

CARE GIVER/EMERGENCY CONTACT (Required)

Primary Contact Name:

Email Address:

Address:

Relationship to Registrant:

Home Telephone #:

Other Telephone # (optional):

Secondary Contact Name (optional):

Address (optional):

Relationship to Registrant (optional):

Home Telephone # (optional):

Other Telephone # (optional):

_________________________________________________________________

RELEASE (Required)

I, for myself and the registrant named above, do hereby authorize the City of Burlington Police Department to release the aforementioned information in response to emergency calls (to include missing person reports) regarding the registrant and do further agree to indemnify and hold harmless the City of Burlington Police Department and persons associated.

 

 

Comments are closed.