Who can apply for the Placentia Y.A.N.A. program?

The client may request enrollment, or a legal guardian may request it on the client’s behalf. The form asks for client, contact, emergency, household, and health information.

Do I need a notary for the Y.A.N.A. application?

No. The client or legal guardian and a witness sign and date the form. It does not identify a notarized or sworn attachment.

How do I submit the Y.A.N.A. application?

The form does not state how to submit the initial application. Submit it to the city department named on the form; check the city website for current contact details.

Should I submit the emergency form with my packet?

No. The emergency form says not to submit that page with the packet. Complete it and place it somewhere highly visible in the home.

Placentia, CA · Orange County

No notary required

You Are Not Alone (Y.A.N.A.) Application / Waiver Form

Placentia residents or their legal guardians use this application to request enrollment in the Police Department’s voluntary You Are Not Alone program.

What this form is

This application requests enrollment in Placentia’s You Are Not Alone (Y.A.N.A.) program, which provides check-in visits or calls as staffing permits. It asks for client and guardian details, preferred contact arrangements, emergency contacts, household members, pets, and health information. The client or legal guardian reviews the program terms and signs the waiver; a separate emergency form is for the home, not for submission with the packet.

Who needs it

A Placentia resident seeking Y.A.N.A. enrollment, or the resident’s legal guardian, completes and signs the application and waiver.

How to submit it

Submit it to the city department named on the form; check the city website for current contact details.

About notarization

This document is signed and dated by the client or legal guardian and a witness; it identifies no notarized or sworn attachment.

How to submit this form

1
Download The Application
Download the Y.A.N.A. application and waiver for the client or legal guardian to complete.
2
Complete The Request Form
Fill in client and guardian details, preferred check-in arrangements, emergency contacts, household information, and the requested health information.
3
Prepare The Emergency Form
Complete the separate emergency form and place it somewhere highly visible in the home. Do not submit it with the packet.
4
Sign And Submit
Have the client or legal guardian and a witness sign and date the application. Submit it to the city department named on the form; check the city website for current contact details.

Frequently asked questions

Who can apply for the Placentia Y.A.N.A. program?: The client may request enrollment, or a legal guardian may request it on the client’s behalf. The form asks for client, contact, emergency, household, and health information.
Do I need a notary for the Y.A.N.A. application?: No. The client or legal guardian and a witness sign and date the form. It does not identify a notarized or sworn attachment.
How do I submit the Y.A.N.A. application?: The form does not state how to submit the initial application. Submit it to the city department named on the form; check the city website for current contact details.
Should I submit the emergency form with my packet?: No. The emergency form says not to submit that page with the packet. Complete it and place it somewhere highly visible in the home.

Need something notarized?

This You Are Not Alone (Y.A.N.A.) Application / Waiver Form doesn’t need a notary — but if you have another Placentia form that does, a commissioned online notary can help.