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Silver Citizen Program Sign Up Form

  1. Silver Citizen Database
    The Little Elm Police Department has developed a Senior Citizen database that stores information should an urgent matter arise that involves one of our senior citizens. If there is anyone in your life that you would like included in this database, please take a moment to register them. Officers will use the information to assist in locating a lost citizen or any other urgent situation. A recent photo of the senior citizen is required. The form can be completed electronically, or in person at the Little Elm Police Department (88 W. Eldorado Pkwy., Little Elm, TX 75068. A recent photo of the senior citizen will be required. Contact the Community Service Division at 972-377-1885 with any questions.
  2. Gender*
  3. For Example: Villages of Woodlake, Sunset Point
  4. Does the Individual Wear Glasses?
  5. Does the Individual Use a Walker?
  6. Does the Individual Use a Wheelchair?
  7. Is the Individual Deaf?
  8. If so, Do They Know Sign Language?
  9. Does the Individual Suffer from Dementia or Alzheimer's Disease?
  10. Does the Individual Drive?
  11. Please provide any other useful information that may be helpful, such as favorite places to go, any schedules they keep, friends, favorite clothing, hobbies, etc.
  12. Leave This Blank:

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