As members of the Madison County Sheriff’s Office, we recognize that our community has a large senior population who live alone or have special needs.
Sheriff Harper has implemented a program within the Sheriff’s Office that is designed to provide our seniors and their families with a sense of security while respecting their independence. Once a consenting participate is registered, a Madison County Sheriff’s Office Communication’s officer or designated volunteer will call each morning between the hours of 9 and 11 am to check on their well-being. If the call does not get answered after a couple of attempts, a deputy will be dispatched to respond to the address on file to check on the participant in person. The caller will also reach out to the emergency contact or key holder if necessary. All information in the participation form will be kept completely confidential. If you or someone you know would like to be a “Silver Star” or volunteer, please contact the Madison County Sheriff’s Office at (850) 973-4151 or Major Doug Haskell at (850) 253-3311.
Agreement & Consent
I hereby consent to and authorize the Madison County Sheriff’s Office “Silver Star Club” coordinator or his/her designee, to receive certain personal information about myself from my family or primary care physician, as necessary, as it may pertain to my well-being.
I request and authorize the Madison County Sheriff’s Office to send a Madison County Deputy Sheriff to my listed address on file in attempt to make physical contact with me should I not answer the phone when called, and after all other listed contacts have been attempted by Madison County Sheriff’s Office personnel or authorized designee, to ensure my safety and well-being.
I request and authorize entry be made into my residence, if deemed necessary to ensure my safety and well-being, after all other reasonable attempts to contact me have been exhausted including my designated emergency contact person, my family and/or my primary care physician. In the event “forcible entry” is required to access my dwelling, I release and hold harmless the Madison County Sheriff’s Office and Madison County Sheriff’s Office personnel of any and all liability to include but not limited to physical property damage resulting from forced entry to ensure my safety and well-being.
I understand that it is my responsibility to make aware the Madison County Sheriff’s Office, the “Silver Star Club” coordinator, or his/her designee of my extended absence and upon my return.
Typing your name and the date in the space provided will serve as your electronic signature and your agreement with all of the above listed statements. By submitting the form, I hereby acknowledge that I have completed the above information fully and accurately.
