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2. 
4. UPDATE US ON YOUR LOVED ONE

   Please note that you will only be able to submit UPDATED INFORMATION if the Full Registration has been completed. If you have not completed the registration please do so now - 

   • Register your loved one here for City Safe and Sound         (online form)
   • Print and paper here (Fax/Post/Drop it off) Hand it to an officer
6. Full Legal Name:*
8. Updated Image:
10. Date of update:
    Date of update:
12. Updates on Diagnosis:
14. Updates on Triggers or Fears:
16. Any other updated information
18. Submitter contact information

    As a caregiver to this individual, I agree to share all the listed information with Kinston Police Department, Kinston Fire Department, and Lenoir County Emergency Services. I am aware that this information is voluntary and will only be used to ensure the safety of the listed individual if contact is needed by any of the listed agencies.

20. Name of Submitter:
21. Updated Email Address for you
Leave This Blank:


23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit

* indicates a required field