Project H.O.M.E.

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 Project HOME_program logo_F

 

Project H.O.M.E. is a program for people who may need special assistance in times of emergency. This kind of assistance may be required if the person is unable to speak or properly identify themselves, if they become disoriented, or if they may act in a manner that could be misinterpreted by first responders.

Project H.O.M.E. stands for “Help Our Missing and Endangered”, and was inspired by the Take Me Home program started by the Pensacola Police Department. It is intended to assist Carrollton residents with cognitive impairments. This includes individuals with autism, dementia, Alzheimer’s, down syndrome, or traumatic injuries. Caregivers or special needs individuals can voluntarily enroll themselves into our private database by completing a simple form and submitting a current photo of the individual. Current photographs submitted should resemble a passport style photo or picture taken professionally by a school photographer.


If the loved one is found wandering, an officer can quickly search the database for people who match their physical description. The database will pull up the individual’s Project H.O.M.E. application, which includes medical information and emergency contacts, to quickly and return them to their caregivers. This database also works in reverse – if a caregiver calls our dispatch to alert us that their loved one is missing, all of their pertinent information will already be accessible through this private database.

Project H.O.M.E. applications allow caregivers to inform first responders of valuable information that may assist in theOfficer_Child reunification process. Citizens have the ability to fill out an electronic application below or print a PDF version and submit it at the Police Department. Any questions about Project H.O.M.E. can be sent to ProjectHOME@cityofcarrollton.com .  

Project H.O.M.E. is voluntary all information is confidential. There is no enrollment fee, however there is a commitment to keep the system and information current. Participants are encouraged to submit a new photo every year, and to update addresses or emergency contact information whenever they change.  


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

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 CARROLLTON POLICE DEPARTMENT

Project H.O.M.E


IDENTIFYING INFORMATION:


 Name:
 *
Nicknames:
Sex:
Sex:
Race:
Race:
Ethnicity:
Ethnicity:
Date of Birth:
 *
Height:
 *
Weight:
 *
Hair Color:
 *
Eye Color:
 *
Identifying Markers (scars, marks, tattoos, glasses, piercings, etc.):
Home Address:
 *
Home Address:
School Name and Address (if applicable):
School Name and Address (if applicable):
Vehicle Information (if applicable):
Vehicle Information (if applicable):

MEDICAL INFORMATION:


Type of Disability:
Check if Applicable
Check if Applicable
Known Allergies:
Other Pertinent Medical Information:
Attach a photo:
 *

EMERGENCY CONTACT INFORMATION


Name:
 *
Relationship:
 *
Contact Information
 *
Contact Information
Home Address:
 *
Home Address:
Name:
Relationship:
Contact Information
Contact Information
Home Address:
Home Address:

Additional Information:


Where is your loved one known to go, or is there a special interest (outside of your residence) that they are drawn to?
(Example: parks, malls, water, trains, Rec Center, etc.)
Is your loved one verbal or non-verbal? Please explain.
Does your loved one fear police or fire/EMS personnel or emergency vehicles? Lights and sirens? Please explain.
If your loved one becomes confrontational or frightened, how could officers or rescue personnel calm then without your presence?
Does your loved one have any known triggers? (Example: reaction to touch, loud noises, bright lights)
Are there any visual or verbal prompts that might be helpful to officers when assisting your loved one? (Example: keywords they react positively to, pictures of items, positive thoughts that might encourage them to stay calm when lost)
Is there any other information you can provide that may be helpful when we are assisting your loved one?


I hereby attest that I am authorized to provide all of the foregoing information to the Carrollton Police Department.
 *

I further attest that I am freely and voluntarily providing the information contained in this form and a photograph to the City of Carrollton Police Department and the North Texas Emergency Communications Center (NTECC) with the express intent that the Department and NTECC maintain the information in its files and may use the information for any lawful purpose. I understand that certain information in this form may be considered protected medical and/or identifiable health care information. I further understand that the Department and NTECC are not health care providers and/or covered entities under HIPPA for the purposes of collection and use of any protected medical and/or identifiable health information.

 *
I further attest that I am freely and voluntarily providing the information contained in this form and a photograph to the City of Carrollton Police Department and the North Texas Emergency Communications Center (NTECC) with the express intent that the Department and NTECC maintain the information in its files and may use the information for any lawful purpose. I understand that certain information in this form may be considered protected medical and/or identifiable health care information. I further understand that the Department and NTECC are not health care providers and/or covered entities under HIPPA for the purposes of collection and use of any protected medical and/or identifiable health information.
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