Project Lifesaver Referral

Please tell us about yourself! We’d like to learn more about who’s completing this application.


Check your preferred method of communication?*
EmailPhone
Best time to call?*
AMPM


What is your relationship with the potential Project Lifesaver Participant?* (Check all that apply)
Authorized RepresentativePrimary CaregiverOther




Thank you! Now, please tell us a little more about the potential Project Lifesaver Participant:



Choose which of these best suits your request*:
I’d like to purchase this device as soon as possible.I’m interested in being placed on the waitlist for a free device.
I understand that free devices are distributed based on supply. A free device is not guaranteed, and receiving a free device may take additional time.



By submitting this online application, you are acknowledging that:
I have reviewed this application and certify that it is accurate and true to the best of my knowledge. I understand that the information I provide will be confidential and will only be used to determine the efficacy of the Project Lifesaver program. I acknowledge that my participation in the Program is voluntary and does not involve public interests. I understand that the use of this device does not ensure the safety of the participant. This is a tracking tool to assist in the locating of a participant. Moreover, there is no assurance that a participant will be located via this tracking device. I also release all liability from the County of Los Angeles, its Departments and the Project Lifesaver vendor.


We will contact you to schedule a phone interview with the authorized representative. Due to the volume of inquiries, this may take up to 3-5 business days.