Take Me Home Registration Form

Take Me Home Program

Person Information
This sign up form is intended for Kansas residents.

The information of the person on this form will be entered into the Johnson County Sheriff's Office Take Me Home program within the next 30 days.

Please Note:  Should there be any changes, it is the responsibility of the legal guardian or representative to notify the Sheriff's Office so that the program will contain the most up-to-date information.

Helpful Information for the Take Me Home Candidate
Emergency Contact Information
Main Emergency Contact
Other Emergency Contacts
Other Emergency Contacts
Other Emergency Contacts
Photo Attachment
Files must be less than 5 MB.
Allowed file types: gif jpg jpeg png.
Requester Information (Please Enter your name and contact information)
Enter the characters shown in the image.