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LPD Vulnerable Citizen's Registry

  1. Vulnerable Citizens Information
  2. Gender
  3. Caregiver's Information
  4. Please upload a photograph of the citizen being registered.  Please post a clear photo of the citizen's face.

  5. E- Signature Verification

    I acknowledge that by clicking the above verification box below that the information being provided is truthful, current, and valid and that I am authorized to submit it on my behalf or as the legal guardian with authority to submit it on behalf of another. I further understand that by enrolling myself or someone else in the Lilburn Police Registry for Vulnerable Citizens, that the personal information entered may be used by emergency personal, including, but not limited to, law enforcement officers, emergency medical services (first aid/paramedics), and fire department personnel in the event of a personal emergency or other emergency situation. It is further understood that completion of this form and participation in the Lilburn Police Registry for Vulnerable Citizens is voluntary and cannot guarantee and is not intended to convey and warrant, either express or implied, as to outcomes, promises, or benefits from the use of this form and participation in this program. By signing below, I also acknowledge that I understand the disclaimer. 

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