EMERGENCY CONTACT FORM

This form is for non-emergency communication only. To report an emergency, please dial 911. Your submission is important to us. Please include your phone number and/or email address so we may contact you regarding your submission if needed. 

The information contained on this form will be kept on file and used by law enforcement to notify a designated emergency contact  person when another person goes missing or is located who has a cognitive disorder and who is prone to wandering, a life threatening behavior.  Provide accurate and up-to-date information and a photo of the person.  Please update this form or print and mail the form to our office anytime information changes.  Form submissions via our web site are encrypted for security, however, if you choose to mail the form please mail to:

Leavenworth County Sheriff's Office
601 S 3rd St.
Suite 2007
Leavenworth, KS 66048

Alternately you may click here to print a short form for mailing or call the Leavenworth County Sheriff's Office at (913) 682-5724 to provide the information by telephone.