Identification of Vulnerable Person

Surname:

Given Names:

Home Address:

Date of Birth (YYYY-MM-DD):

Sex:

Phone:

Employer/School:

Employer/School Address:

Caregiver Contacts

Name:

Address:

Preferred Language:

Relationship:

Phone(H):

Phone(W):

Email:

Phone(C):

Medical Contacts

Name:

Address:

Preferred Language:

Relationship:

Phone(H):

Phone(W):

Profile of Vulnerable Person

Race:

Hair Color:

Complexion:

Hair Description:

Height:

Eye Color:

Weight:

Languages Spoken:

Remarks:

Unique Descriptions:

• None
• Repeat (1 to 4 times)
• Habitual (Over 4 times)

• Alone
• With Family
• Institution
• Other

• Right
• Left
• N/A

• Upper
• Lower
• N/A

• Contacts
• Glasses
• N/A

• Allergies
• Medication being taken
• Medical conditions
• etc.

• Tattoos
• Scars
• Deformities
• Marks
• Amputations
• etc.

Vulnerable Person Details

Method of Communication:

dentification Worn:

Favourite attractions/locations where person may be or any fixations that may attract:

Best method of approach:

Life threatening medical concern:

Any other relevant information:

Information should also include what NOT to do:

It is acknowledged that it is your responsibility to ensure that the information so collected is current and valid, and that the Kennebecasis Regional Police Force is notified in writing of any changes. Annual registration is required to keep your form active. It is the responsibility of the applicant to re-submit the form. It is recommended that you re-submit on the registrant’s birthday to make it easier to remember.
Please include a recent photo of the Vulnerable Person below: Select image