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"Take Me Home" - A Community Service Identification Program
The Jackson Police Department's "Take Me Home" is designed to provide basic identifying information about the program participant named below in case of an emergency; in the event the participant is lost; disoriented or confuse; cannot verbally respond; or is otherwise in need of emergency of other assistance which can be provided by law enforcement personnel.
Participant's Personal Information
Current Photo*
Upload a current headshot (head and shoulders)
First Name
Last Name
Nickname
Address
City
State
Zip
School
Date of Birth
Gender
Race
Hair Color
Eye Color
Height
Weight
Disability
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Additional Helpful Information
Favorite locations where he/she may be found
Atypical behaviors/characteristics that may attract an officer's attention
Favorite toys, music, topics, likes/dislikes, etc.
Preferred method of communication
Additional identification information (Does he/she wear/carry jewelry, tags, ID card, medical alert bracelet, etc.?)
Enrollment affirmation
My signature below constitutes an affirmation under oath that I am legally responsible for the person named above; that I have the legal authority to execute this "Take Me Home" Program Enrollment Form on his/her behalf and for whom I have provided the information set forth herein; and that I consent to have this information shared among law enforcement personnel for enrollment in the "Take Me Home" program.
Name of Individual Completing Form*
Email Address*
E-signature Consent Disclaimer
By clicking the “Submit” button, you are signing this form electronically and agreeing that your electronic signature is the legal equivalent of your manual signature.

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