Saginaw Township Police Department
The Saginaw Township Police Department recognizes that the demographics of our community includes members that have special needs. We have developed this voluntary online registration form to assist caregivers of Alzheimer’s, wandering or other cognitive issues patients.
The data provided is to be used to assist in the investigation of a person who is reported
missing or that has been located but is not able to articulate their address to officers.
This fields below pertain to the name and physical description of the patient.
Please enter the patients first and last name.
Please the patients date of birth.
Please enter the patients race.
Please enter any significant identifying marks such as scars, tattoos, missing limbs or amputations.
We try to attach photos to the completed form. (best size is 200pixels by 200pixels.)
Please provide the name of the facility the patient attends.
This section will pertain to medical information regarding the patient that we we should be aware of.
Please provide any additional medical information you find pertinent.
Does the patient have any peculiar habits that might help in locating or identifying them?
This area is provided to offer a description of any vehicles the patient may have access to.
Please enter the closest match to the color fo the vehicle.
Please provide the information for the person completing this form.
Please provide a telephone number that you can be reached in case of emergency. Preferably a cellular telephone that you have with you on a regular basis.
Please provide your relationship to the patient.
Please provide the name of an additional person we may contact in the event we aren't able to reach you.
By sending this form, I give my permission for the Saginaw Township Police Department to retain this information, to be kept confidentially on file for the
purposes of identification and assistance relative to ALZHEIMER’S / WANDERER / COGNITIVE ISSUES ALERT efforts and related to investigative activities.
This form must have an electronic signature.