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Blaine County Sheriff's Vulnerable Population Registry is a service to aid those who are a part of a vulnerable population, such as those who suffer from dementia, Alzheimer's Disease, Autism, or other special needs living in Blaine County, Idaho.
The registry provides vital information to police, fire, and paramedics to address the specific needs of the people on the registry if there is a call for service. The information can help first responders to provide the assistance needed and return the vulnerable individual home in a timely safe manner.
To help us, please complete as much information as possible. You must be a family member to add someone to the database. Non-family members can request special permission. All registrations are approved by Chief Deputy Fruehling. The registry is voluntary and confidential. Information will only be shared with other Blaine County first responder agencies if there is a call for service.
If you have any questions regarding the Vulnerable Population Registry, please send an email to firstname.lastname@example.org
We will get back to you as soon as possible.
Approximate if Unknown
Such as insulin, requires daily meds, oxygen, etc.
(Verbal, Non-Verbal, Hearing Difficulties, Picture/Assisted Communication Devices, Sign Language, etc.)
(Places they like to go, things they are drawn to, or where they have gone in the past, etc.)
(Catchphrases or words the person likes to use or repeat. Topics the registered person enjoys talking about.)
You must be a family member to add someone to the registry. Non-family members such as physicians, caregivers, or those with legal guardianship can request special permission.
Attach identifiers such as pictures of the individual, their vehicle, or tattoos, etc.
The undersigned certifies that (s)he is the person they claim to be and has filled in this Vulnerable Population Registry application truthfully and to the best of his/her knowledge. Knowingly providing false information may be subject to criminal prosecution. The undersigned grants permission to the Blaine County Sheriff Office, Blaine County Emergency Communications, or another designated Blaine County first responder agency to use the information provided to assist the registered vulnerable person without legal penalty. All information will be kept confidential.
By checking the "I agree" box below, you agree and acknowledge that:
1) Your application will not be signed in the sense of a traditional paper document;
2) By signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature;
3) You may still be required to provide a traditional signature at a later date;
4) You must agree with the above acknowledgment to submit this registration application.
This field is not part of the form submission.
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