Take Me Home is intended to assist those who are unable to communicate or properly identify themselves in the event they become disoriented and those who may act in a manner that could be misinterpreted by first responders.
The form below requires information such as a current digital picture, demographic information and caregiver contacts.
We will send you an email reminder when it is time to submit an updated photo and information.
i.e. tattoos, piercings, etc.
Check all that may apply.
i.e. wonders to a favorite place
i.e. ID card or medical alert bracelet
Please list identification number if applicable.
i.e. EmFinders or LoJack SafetyNet Transmitter number?
My electronic response of 'YES' constitutes an affirmative under oath that I am legally responsible for the person names above for whom I have provided information, and that I consent to have this information shared among law enforcement personnel for enrollment in the 'Take Me Home' program.
This field is not part of the form submission.
* indicates a required field