Lexington Police Department

safewatch@lexingtonma.gov

1575 Massachusetts Ave. Lexington, MA 02420

General Non-Emergency: 781-862-1212

Safe Watch Enrollment Form

For questions or concerns regarding this program or this form, please contact Detective Chris Ducharme at 781-862-1212 ext 39262, or email safewatch@lexingtonma.gov

Submitter's Information

Relation to Individual:

Phone Number:

Email address:

Subject's Profile

Nickname:

Race/Ethnicity:

Gender:

Male

Female

Weight (lbs):

Height:

Eye color:

Hair color:

Identifying Marks:

Identifying Items:

Please upload a recent photo of the individual:

Click Here to Upload

Habits/Preferences:

Is this person likely to wander?:

Yes

Favorite attractions or places:

Distinguishing Behaviors/Signs of Distress:

Favorite Objects, Toys, Topics/Other Likes or Dislikes:

Effective Approaches/De-Escalation Techniques:

Preferred Communication Methods:

Does this person drive?:

Yes

Car License Plate:

Car Make:

Car Model:

Car Model Year:

Car Color:

Emergency Contact Information:

Primary Contact:

Relation to Individual:

Phone Number:

Email address:

Preferred Language of Primary Contact:

Alternate Contact #1:

Relation to Individual:

Phone Number:

Email address:

Preferred Language of Alternate Contact #1:

Alternate Contact #2:

Relation to Individual:

Phone Number:

Email address:

Preferred Language of Alternate Contact #2:

Safe Watch Enrollment Form

Submitter's Information

Subject's Profile

Medical Information

Habits/Preferences:

Emergency Contact Information: