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H.O.M.E. Helping Our Missing Endangered Registration form

  1. PACT Logo 2014small.jpg

  2. INSTRUCTIONS

    Please complete the necessary fields below. This information is being submitted voluntarily and for the sole purposes of assisting us in locating/identifying your loved one. Once your application has been submitted, a P.A.C.T. officer will contact you to arrange for a current photo to be submitted.

  3. This should be an adult responsible person and not the subject of the missing critical registration.

  4. This should be an adult responsible person and not the subject of the missing critical registration.

  5. Participant's Information

    Please provide the following information on the person participating in the program.

  6. Please put in the legal first name of the person that is being registered.

  7. Please put the legal middle name if applicable.

  8. Please put in the legal last name of the person that is being registered

  9. What name(s) do they use or answer to?

  10. This information is used when entering person into national/state missing persons database.

  11. Please put the residential address of the person being registered. This must be a valid address in Cedar Hill.

  12. Please note any scars, marks, tattoos, amputations, prosthetics, deformations, etc. in the space above.

  13. Please list the person's favorite attractions or locations where they may be found in the space above.

  14. Please provide a list of the person's favorite toys, topics of discussion, things they like and dislike.

  15. Please provide the person's preferred communication method (verbal, sign language, written words, songs, phrases they may respond to)

  16. Please provide any medical alert jewelry information/ GPS tracking devices, etc. If a GPS is worn, please provide the manufacturer and transmitter number if applicable.

  17. If person may become combative if restrained, confronted etc., please provide information below regarding triggers or methods used to deescalate the situation.

  18. Please provide any additional information about the person which may be helpful for first responders.

  19. Please provide us with a basic qualifying diagnosis for this registered person.

  20. Physician Documentation

    Notice: Documentation is required to issue an alert

  21. Please list any other medical conditions.

  22. Please provide the names of any prescribed medications taken by the person.

  23. Vehicle Information

    Please provide information for any vehicle the person has access to, regardless of current driving status.

  24. EMERGENCY CONTACT INFORMATION

    Please provide the following information for other primary caregivers and emergency contacts other than yourself.

  25. Acknowledgement & Release

    I give the City of Cedar Hill, Cedar Hill Police Department and its representatives permission to disseminate information included in this application, and/or acquired through the investigation of a missing person, as deemed necessary to locate the applicant in the event s/he is reported missing or endangered in any way that requires law enforcement assistance. I understand that personal information may be disseminated to other public safety agencies, media outlets, volunteer organizations and the general public and do not hold the City of Cedar Hill, the Cedar Hill Police Department or its representatives liable for any misuse of personal information.

  26. By printing your name, you acknowledge and agree to the above statement.

  27. Please provide a current photo (within the last week) of the participant. Please do not use a photo of a photo. The photo should be clear, in focus, and not dark in color due to lighting.

  28. Thank you for taking the time to provide this valuable information to the Cedar Hill Police Department. Our goal is to quickly and safely get your loved one home. Someone from P.A.C.T. (Police And Community Team) will contact you in the coming days to get further details for full registration.

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  30. This field is not part of the form submission.