Who completes the Project Lifesaver application?

A legally responsible party, such as a spouse, family caregiver with primary responsibility, or facility administrator, requests enrollment and completes the application.

What information does the application ask for?

It asks for caregiver contact details, the applicant’s identifying and medical information, wandering history, and a physician’s signature verifying that the applicant may be at risk for wandering.

Do I need a notary for the Project Lifesaver application?

No. This document is signed without a notary. The applicant’s physician signs to verify wandering risk; power of attorney or guardianship letters are attached if needed.

How do I submit the Project Lifesaver application?

Fax, mail, or email it to the Menominee County Sheriff’s Office, Attn: Project Lifesaver. The form lists the office address, fax number, and email address.

Menominee County, MI · Menominee County

No notary required

Project Lifesaver Program Application and Contract

This application and contract enrolls an individual at risk of wandering in Menominee County’s Project Lifesaver program and is completed by a responsible caregiver.

At a glance

Issued by: City of Menominee County · Menominee County, Menominee County, Michigan
Notarization: Not required: file this form without a notary.
Official source: menomineecountymi.gov
Blank form: Download the PDF
Catalogued: Oct 5, 2026
Machine-readable: JSON record · about the forms index

What this form is

The package includes a program application, liability release, enrollment contract, client profile questionnaire, and caregiver instructions for Project Lifesaver. A legally responsible party requests enrollment; the application asks for caregiver and applicant details, medical information, and a physician’s signature confirming wandering risk. The contract describes caregiver responsibilities, equipment use, and a $10 monthly maintenance fee.

Who needs it

A legally responsible party seeking Project Lifesaver enrollment for an individual with Alzheimer’s disease, autism, or a related disease completes the application.

How to submit it

Fax, mail, or email the application to the Menominee County Sheriff’s Office, Attn: Project Lifesaver, 831 Tenth Avenue, Menominee, MI 49858; fax 906-863-2239 or email [email protected].

About notarization

This document is signed without a notary; the applicant’s physician signs to verify wandering risk, and power of attorney or guardianship letters are attached if needed.

How to submit this form

1
Download the Application
Download the Project Lifesaver application and contract package.
2
Complete the Application
Provide caregiver and applicant information, medical details, and the required signatures, including the physician’s verification of wandering risk.
3
Gather Supporting Documents
Attach power of attorney or guardianship letters if needed.
4
Submit to the Sheriff’s Office
Fax, mail, or email the application to the Menominee County Sheriff’s Office using the contact information on the form.

Frequently asked questions

Who completes the Project Lifesaver application?: A legally responsible party, such as a spouse, family caregiver with primary responsibility, or facility administrator, requests enrollment and completes the application.
What information does the application ask for?: It asks for caregiver contact details, the applicant’s identifying and medical information, wandering history, and a physician’s signature verifying that the applicant may be at risk for wandering.
Do I need a notary for the Project Lifesaver application?: No. This document is signed without a notary. The applicant’s physician signs to verify wandering risk; power of attorney or guardianship letters are attached if needed.
How do I submit the Project Lifesaver application?: Fax, mail, or email it to the Menominee County Sheriff’s Office, Attn: Project Lifesaver. The form lists the office address, fax number, and email address.

Need something notarized?

This Project Lifesaver Program Application and Contract doesn’t need a notary, but Michigan residents can notarize other documents online with a commissioned online notary.