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Hazlet Township Police Department

Senior Citizen/ Disabled resident's emergency contact form


Full Name

Full Address

Emergency Contact #1

EC #1 Address

Emergency Contact #2

EC #2 Address

The Hazlet Township Police Department is seeking information on township senior citizens and disabled residents in case they need special attention in the event of an emergency. The form may be completed by the person seeking assistance or a friend or relative. Hazlet residents are encouraged to submit this form and to make other aware of the form’s availability.

All information will be kept confidential.