• The Chandler Police Department will collect and retain the listed information. Chandler Police and Chandler Fire will utilize this information to respond to calls for service involving the person(s) registered in order to promote effective interaction with him/her, and, if applicable, return the person home or to another resposible person(s).

• Chandler Police and Chandler Fire Departments will not share or distribute personal information gathered by this form except as required by law and will use it solely for the purposes stated in this document.

• It is my responsibility to ensure the information submitted is current and accurate, and to notify the Chandler Police Department in writing of any changes.

• I may request that the information in this form be withdrawn at any time.

• Unless I withdraw the information beforehand, the Chandler Police Department will retain the information for a period of three years, after which it will be purged from the system. Before it is purged, the Chandler Police Department will send notice to me at the address I provide to determine if I want the information to remain on file for another three years. If the Chandler Police Department is unable to contact me at the address provided, I understand the information will be purged.

• By signing below, I certify that I have the authority to submit the listed information on behalf of the person to be registered. I understand the terms of this document and consent to the use of the information for the stated purposes.