Harwood Heights, IL · Cook County
I Live Alone Program Form
Harwood Heights seniors or family members submit this form to register a senior for weekly well-being calls from the Department.
What this form is
This form registers a senior citizen for the Village’s I Live Alone program, through which Department personnel call every Saturday to check on their well-being. It requests the senior’s contact details, emergency contacts and key-holder information, family doctor, church, and known medical concerns. If personnel cannot reach the senior after several attempts, the form says an officer will be sent to check on them.
Who needs it
A senior citizen or family member can request and complete this form to register the senior for the program.
How to submit it
Mail or email the completed form to Commander Steve Biagi at Harwood Heights Police Department, 7300 W. Wilson, Harwood Heights, Illinois 60706, or [email protected].
About notarization
This form is completed without a notary; it mentions no sworn or notarized attachment, and asks for contact and medical information.
How to submit this form
- 1
Download The Form
Get the I Live Alone Program Form.
- 2
Complete The Form
Provide the senior’s contact details, emergency contacts, key-holder information, family doctor, church, and known medical concerns.
- 3
Gather Requested Information
Have the emergency contact and medical information requested by the form ready.
- 4
Submit The Form
Mail or email the completed form to Commander Steve Biagi at the address or email listed on the form.
Frequently asked questions
- Do I need a notary for the I Live Alone Program Form?
- No. The form has no notary block and mentions no sworn or notarized attachment; it asks for contact and medical information.
- Who can request the I Live Alone Program Form?
- The document says a senior citizen or a member of their family can contact the Village requesting the form.
- How do I submit the I Live Alone Program Form?
- Mail or email the completed form to Commander Steve Biagi at the Harwood Heights Police Department, 7300 W. Wilson, Harwood Heights, Illinois 60706, or [email protected].
- What happens after a senior registers?
- Department personnel call the senior every Saturday. If they cannot reach the person after several attempts, the document says they will send an officer to check on their well-being.