Please complete this form to register a person with the DeLand Police Department. Your Contact Information First Name * Last Name * E-mail Address * Phone Number * Handle with Care Person First Name * Last Name * Date of Birth * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year19071908190919101911191219131914191519161917191819191920192119221923192419251926192719281929193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022 Race(s) * Gender * - Select -MaleFemale Height * Weight * LocationAddress: Get Address from Map MarkerMap MarkerUse Location Address | Use My Current LocationHint, click the map to add or drag a GPS Marker. Zoom in for a better view. Organization / Building / etc Street Address * Apartment / Suite Number City * State * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code * InformationInclude school/work info, car info, triggers, calming methods, service animal, etc. Additional Notes / Condition / Consideration * Photo Attach a photo (jpg, jpeg, png) of the person. Emergency ContactsInclude as much contact information as possible, e.g. name, address, phone, etc. Emergency Contact #1 * Additional Emergency Contacts Agree * I understand that submitting a false report is punishable by law. Leave this field blank Submit