The Racine Police Department in partnership with Racine County Aging & Disability Resource Center, and The Volunteer Center of Racine, has developed the Autism/Alzheimer/Dementia Elopement Alert Form. The form will permit the Care Provider of an individual with Autism, Alzheimer, or Dementia to inform the Racine Police Department and other First Responders about the special needs related to the individuals that may wander or get lost. Completing and submitting this form is voluntary.
The Autism/Alzheimer/Dementia Elopement Alert Form will be used for the care of Individuals that are lost or found that cannot communicate or may not be able to fully care for themselves. The details provided by completing this form will speed up verification of data about the missing individual. It will also allow the Racine Police Department to disseminate the information to First Responders and Search Personnel sooner. A Photo should be included, as it will help us identify the individual more efficiently.
Once the information is submitted, responsibility to update the data falls on the Care Giver. An update can be done by resubmitting this form with the corrections. We recommend updating all data changes as soon as possible and recommend providing a photograph less than two years old which accurately resembles the individuals current appearance. By filing this form with the Racine Police Department, the data is instantly available to communicators and responding officers.
If a Care Giver is not comfortable submitting this form to the Police Department, we would recommend filling out and printing the form. The completed form can be given to the First Responder at the time the individual is reported missing.
Racine Police Department recommends you consider using a program like Safe-Assured to properly document your loved ones photo and identifying characteristics. Safe-Assured documents are more complete but will require more time before they can be disseminated to First Responders. Programs like Safe-Assured will provide wider dissemination of the information when the local attempts are not immediately successful.
If you need more information on resources, Racine Police Department recommends contacting Racine County Aging & Disability Resource Center of Racine County at http://www.adrc.racineco.com/ or 262-833-8777.