The Garden City Police Department has a Safety and Wellness Program that is available to all Garden City Senior Citizens and/or residents with severe medical conditions. Residents who take advantage of this program are put on a list and are asked to call the Police Department daily. If the resident fails to contact the Police Department, the Department will call the resident and if there is no answer, a police officer will be sent to check on the resident.

Any resident who wishes to take advantage of this program may call the Garden City Police Department at 516-465-4100 to request an application. The application requires the following information:

* Your Name, Address, Primary and Secondary Phone Numbers, and any special conditions that apply to you.

* Name, Address and Phone Numbers of next of kin, emergency contacts or key holders .

* Name, Address and phone number of Primary Physician.

Safety And Wellness Program Application

Your Information

Name:_______________________________________________________

Address:_____________________________________________________

Primary Phone:____________Secondary Phone:__________________

Emergency Contact 1

Name:_____________________________Relationship_____________

Address:_____________________________________________________

Primary Phone:____________Secondary Phone:__________________

Does this contact have a key to your home? Yes___ No ___

Emergency Contact 2

Name:_____________________________Relationship_____________

Address:_____________________________________________________

Primary Phone:____________ Secondary Phone:__________________

Does this contact have a key to your home? Yes___ No ___

Primary Physician

Name:_______________________________________________________

Address:_____________________________________________________

Office Phone:______________Emergency Phone:_________________

Use the space below to provide information about any special conditions that apply to you. (Examples: On Oxygen, Life Support, Heart History, Etc).

_____________________________________________________________

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