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Senior Citizen Call-In Program

Instructions:
The Senior Citizen Call-In Program requires the senior citizen to call the Norcross Police Department Dispatch Center every day by the predetermined day(s) and time selected. If the senior citizen does not call in by the designated time, the police department will attempt to call the senior citizen. Should there be no response to the attempted contact, an officer will be sent to the address to conduct a welfare check.
General Information
Name:
Birthdate:
Address:
Home Number
Cell Phone Number:
Race:
Gender:
Height:
Weight:
Desired Call Time:
1. 7AM
2. 8 AM
3. 9 AM
1. 10 AM
2. 11 AM
Days Called:
1. Sunday
2. Monday
3. Tuesday
1. Wednesday
2. Thursday
1. Friday
2. Saturday
Special concern or medical condition:
Medications:
Do you live alone?
1. Yes
1. No
If not, who else do you live with?
Do you keep a key hidden outside of the home?
1. Yes
2. No
If yes, where is the key hidden?
Primary Care Physician:
Phone:
Hospital Preference:
Do you drive?
1. Yes
1. No
Vehicle Make:
Model:
Year:
Color:
License Plate:
State:
Animals on premises:
1. Yes
1. No
Type of Animal:
Alarm System:
1. Yes
1. No
Alarm Company:
Phone:
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