DeKalb County Sheriff

DeKalb County Sheriff	100 South Main Street • Auburn, Indiana 46706

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DeKalb County, Indiana Sheriff Emergency Contact Update

Homeland Security Safe at Home Project/Citizens at Risk

Introduction to Project SAFE Home

Please assist us in updating the 9-1-1 system. In times of natural or emergency disaster, Law Enforcement; EMS and Fire Personnel need to be able to identify individuals who may be isolated and/or vulnerable and require assistance. All of the answers will be kept in confidence. Information gathered will be given to Law Enforcement; EMS and Fire Agencies for entry into their computer systems. Please Print Clearly when completing this form.

Contact Information
First Name	Last Name
Address Line1
Address Line2
City
State	Zip
Phone	Cell Phone
eMail

Physical Description
Glasses?	Yes No Contact Lenses? Yes No

Date of Birth

Sex Male Female Height

Weight

Eye Color Hair Color

Race
Scars, Marks, Tattoos

Emergency Assistance
Who has a key to your residence?	Phone:

Do you have a hidden key that Emergency Responders could use?

Yes No
Where?

Do you have any Hazardous Chemicals or explosives located in your home or on your property?

Yes No
Where?

Do you have any Pets that we need to be aware of? If yes, please give us information about them; Type of Pet; Name; who takes of the pet(s) when you are not able to? Does the Pet(s) bite or become vicious? Is there a Pet Cage for the Animal?

Enter Information About Your Pets Here

Medical History and or Special Needs:

Emergency Contact Persons
(1) Emergency Contact Person
First Name	Last Name
Address Line1
Address Line2
City
State	Zip
Phone	Cell Phone

(2) Emergency Contact Person
First Name	Last Name
Address Line1
Address Line2
City
State	Zip
Phone	Cell Phone

Staff Login Staff Email

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DeKalb County Sheriff

DeKalb County, Indiana Sheriff Emergency Contact Update

Homeland Security Safe at Home Project/Citizens at Risk

Introduction to Project SAFE Home