Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Melissa Police Department At-Risk Residents Registration

  1. Disability
  2. Emergency Contact Information
  3. Electronic Signature Agreement

    My signature below constitutes an affirmation under oath that I am legally responsible for the person named above for whom I have provided information and that I consent to have this information shared among law enforcement personnel for Melissa Police Department's Special Needs Program

  4. Leave This Blank:

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