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Guardian Program

  1. Guardian Program Logo without background

  2. Burleson Police Department

    The Guardian Program is designed to assist law enforcement quickly locate missing persons that are endangered due to a diagnosed medical condition that hinders cognitive ability and/or the ability to communicate.

  3. Applicant's Information

    Please provide the following information on the person participating in the program.

  4. Glasses

  5. List/Describe any scars, marks, tattoos, amputations, prosthetics, deformations in the spaces provided.

  6. Medical Information

    Provide the following medical information including the name of the condition causing mental impairment.

  7. Notice: Documentation required to issue alert

  8. Vehicle Information

    Please provide information for any vehicle the applicant has access to, regardless of current driving status.

  9. PRIMARY VEHICLE

  10. SECONDARY VEHICLE

  11. Photos of Person Being Registered

  12. Emergency Contact Information

    Please provide the following information for other primary caregivers and emergency contacts.

  13. PRIMARY CONTACT PERSON

  14. SECONDARY CONTACT PERSON

  15. ALTERNATE CONTACT PERSON

  16. Additional Useful Information

  17. Authorization

  18. I give the City of Burleson, the Burleson Police Department and its representatives permission to disseminate information included in this application, and/or acquired through the investigation of a missing person, as deemed necessary to locate the applicant in the event s/he is reported missing or endangered in any way that requires law enforcement assistance. I understand that personal information may be disseminated to other public safety agencies, media outlets, volunteer organizations and the general public and do not hold the City of Burleson, the Burleson Police Department or its representatives liable for any misuse of personal information.

  19. ******For Office Use Only*******

  20. Applicant name record created?

  21. Emergency contact name record created?

  22. Alert added to applicant name record?

  23. Emailed IT support to add address to GIS map?

  24. Premise alert added to applicant address?

  25. Emailed beat officer?

  26. Packed scanned into applicant name record?

  27. Name record entries/scans/etc verified by?

  28. Leave This Blank:

  29. This field is not part of the form submission.