---

Dear Resident:

The Watertown Police Department is pleased to offer the Watertown-Oak Wanderer (WOW) program dedicated to safeguarding residents of all ages who are prone to wandering due to:

• Alzheimer's disease
• Dementia
• Other medical or mental health conditions

By registering for this program, you may reduce the amount of time expended to locate a relative or friend. The information you provide on the WOW Registration Form will assist law enforcement officials in locating a person who has left home and may not have the cognitive skills to return on his/her own or the verbal skills to give an address. Registering your family member or friend also alerts law enforcement officials to potential triggers and ways to calm the individual.

If you would like to register a family member or friend for the Watertown Police Department's WOW program, please either:

• Print out and complete the registration form by clicking HERE and return it to the Watertown Police Department in person or by mail or;
• The registration form is a PDF “fillable” file with the option to digitally fill in the information of the person you wish to register with program. Digitally completed forms or scans of completed forms can be emailed to records@watertownctpd.org or printed out and returned to the as mentioned
• The Form can also be completed by filling in the information below and clicking the SUBMIT button.

In the event that the person you have registered in this program is missing, dial 911 to report it. Tell the dispatcher that the missing person is registered in the WOW program.

Edit Form

Water-Oak Wanderer (WOW) Program Registration Form

Registrant Information:

Name of Registrant (First, Middle, Last)*

Address:*?

Phone: (Home)

Phone: (Cell)

Cell Phone Service Provider:?

Do they have "Find My iPhone" or other locations services enabled on their Phone or any Smart Devices?*

Yes

No

Date of Birth*

Height:*

Weight:*

Eye Color:*

Hair Color:*

Other Distinguishing Features:

Health Condition:*

Alzheimer's

Dementia

Diabetes

Other

Other Health Conditions: (Describe)

Medications and Frequency of Dosage:

Primary Care Physician Information:

Physician Name:

Physician Phone:

Emergency Contact Information:

Emergency Contact Person: (First, Middle, Last)*

Relationship to Registrant:

Emergency Contact Phone (Home):*

Emergency Contact Phone (cell):*

Emergency Contact Address*

Emergency Contact Email:

Case Worker, Caregiver or Agency Providing Care Information:

Case Worker, Caregiver or Agency Providing Care:

Phone:

Email:

Support Information:

Known Triggers:

Known Calmers:

Name/Nickname registrant will acknowledge when being approached:

Photo of Registrant (multiple photos allowed)

Person Submitting Form:

Submitted by: (First, Last)

Relationship to person being registered in the program:

Phone (Home):

Phone (Cell):