What is the SPECIAL FAMILY MEMBER DIRECTORY?

The Special Family Member Directory is a project in partnership between you, as the community members of the City of Eastlake and the Eastlake Police Department. This online directory promotes communication and enables the police department to have quick and relevant access to important information about a person with a Special Need. This information may be crucial in instances where affected persons wander or are experiencing a crisis situation.
The information submitted about the person may include: name, birthday, physical description, emergency contact information, known triggers/behaviors and more. Having early access to this information may prove crucial to successfully defusing a crisis situation or locating a person that has wandered away from safe surroundings.

Goal of the Program

The goal is to help ensure the safety of individuals with developmental disabilities. Also included in this Directory would be individuals with Alzheimer’s disease and dementia. We want to bring your loved ones safely back home. THIS ROSTER IS CONFIDENTIAL AND AVAILABLE ONLY TO THE POLICE DEPARTMENT.

How to Register

To register your family member, an adult family member — or the guardian of an individual with a developmental disability or dementia — must complete and submit the online form (below).

What happens once the person is registered?

Once the person is registered, their information will be placed into a searchable database in the City of Eastlake Police Department’s record management system. This information will then be available to the officers responding to a call for help or assistance with your Special Family Member. When possible, a specially trained, “Crisis Intervention Team” (CIT) officer will be sent to the scene.

Register Annually

The information must be updated and submitted each year to ensure the information is accurate and up to date.

Step 1 of 12

Person Completing This Form






Step 2 of 12

Special Family Member












Step 3 of 12

Special Family Member Residential Information





Step 4 of 12

Parent or Guardian Information












Step 5 of 12

Symptomatology






Step 6 of 12

Wandering








Step 7 of 12

Characteristics



















Step 8 of 12

Emergency Contact Information








Step 9 of 12

Other Contact





School Contact







Step 10 of 12

Vehicle Information





Step 11 of 12

Additional Information

Attach a recent photograph... Upload a current photograph that only has the person you are submitting for in the picture. (Required)



Step 12 of 12

Release & Submit

RELEASE OF INFORMATION I, hereby give my permission for any first responder agency (including but not limited to police, fire/rescue/EMS/911 dispatch center, search and rescue personnel) to retain and distribute the information contained in this registration form to other first responder personnel for the sole purpose of identification and protection of the person identified above in an emergency or crisis situation. By typing your name in the box, you are agreeing to the release terms posted above.






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