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Senior Watch Program Application Form

Please correct the field(s) marked in red below:

Senior Watch Program Banner

The “Check In” program is for senior citizens who may live alone and desire the opportunity to become part of our call in program. They will decide on a day and time that “they” will call in or check in with the police department. If a call is missed, then an officer will call them or stop over to see if everything is okay (Benefit of this program — the client doesn’t have to be home to call in). 
 
The “Elderly Call” program consists of designated days and times the police department will call the “client’s homes” to check on their welfare. Again, if no contact is made, an officer will be sent to the home to check on their welfare. 
 
The “Senior Watch” program is for seniors who may need our help more than others. These seniors may not have family to check on them or provide assistance. A police officer or a designated volunteer would visit the client once a week (or more) to check on their welfare. Check with program you are applying for below.

Senior Watch Program Brochure

Senior Watch Program Application fillable form

Senior Watch Program Application Printable Form

The Senior Watch Application Form asks for pertinent information and requests the client to choose which program they would prefer to be enrolled in. The least intrusive programs are the “Check In” and “Elderly Call” and the most comprehensive is the “Senior Watch.”

Once the application is received by the police department, it will be entered in a database and a schedule will be created for the client based on the program they chose.

As part of the application process, a “site evaluation” of the client’s home will be completed by a police officer. This evaluation will help determine any safety concerns or any special requirements needed at the residence. Choose one of the following options below and someone will contact you.

 

Contact Information
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Contact Information
Note: All contacts will be made as time is available. If there is no response when contact is attempted then the emergency contact person will be notified. Please advise on extended absences from home and return date.
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