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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.
Upload a current headshot (head and shoulders)
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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.
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.
This field is not part of the form submission.
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