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Guardian Program Application

  1. The Guardian Program is designed to assist law enforcement quickly locate missing persons that are endangered due to a diagnosed medical condition that hinders cognitive ability and/or the ability to communicate. Applicant's Information Please provide the following information on the person participating in the program.
  2. List/Describe any scars, marks, tattoos, amputations, prosthetics, deformations in the spaces provided.
  3. For example, upload image of tattoo(s) or other appropriate images of physical descriptors.

  4. Medical Information

    Provide the following medical information including the name of the condition causing mental impairment.

  5. Notice: Documentation is required to issue alert.

  6. Vehicle Information

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

  7. Photos of Person Being Registered
  8. Emergency Contact Information

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

  9. Primary Caregiver Contact Information
  10. Secondary Contact Person
  11. Additional Useful Information
  12. Authorization

    I give the City of Glenn Heights, the Glenn Heights 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 Glenn Heights, the Glenn Heights Police Department or its representatives liable for any misuse of personal information.

  13. Electronic Signature Agreement
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
  14. Leave This Blank:

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