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City of Woodlawn Park

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Police Department Welfare Check

First Name *

Last Name *

Street Address *

Phone Number *

Cell Phone Number *

Date of Birth *

Height *

Feet

Inches

Weight * lbs

Hair Color *

Eye Color *

Emergency Contact Information #1

Name *

Phone number *

Has Keys to House? *

Yes No

Emergency Contact Information #2

Name

Phone number

Has Keys to House?

Yes No

Reason for requesting the welfare check *

Diagnosis/Illness & Known Medications *

Person Making the Request *

Relationship *

Cancel by Date/Time *

Date

Time

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