Project Lifesaver Application

Start Application Client Information Caregiver (s) Information Review & Submit Application
Deputy Sheriff Fairfax County
Sheriff’s Office
Fairfax County, Virginia
Project Lifesaver
4110 Chain Bridge Road
Fairfax, Virginia 22030
Phone: (703) 246-5431
Project Lifesaver
Project Lifesaver Client/Caregiver Application

This application is designed for custodial caregivers to apply for participation in the Fairfax County Sheriff’s Office Project Lifesaver program. By completing and submitting this form you will be considered for participation in Project Lifesaver. You will be sent additional materials to complete, and assigned a place on the waiting list. The following information applies to our policies concerning the waiting list.

  1. Clients will be taken off the waiting list and put into Project Lifesaver Program as space becomes available or at the discretion of the Program Coordinators
  2. If a potential client is referred to us that has a documented (police report) case of wandering, they will be given priority over potential clients with no documented cases of wandering.
Date of Application: 02/13/2026
Confirmation Number:
Client Information
Sex:
Vital Status:
Ever Been Lost Before?
Were Law Enforcement Authorities Notified?
Caregiver (s) Information
Caregiver 1
Optional Caregiver 2
Optional Caregiver 3
OptionalCaregiver 4
Review & Submit Application Information
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Client Information
Client Name:
Client Address:
Unit:
Cellular:
Home Phone:
Work Phone:
Date of Birth:
Sex:
Hair Color:
Eye Color:
Height:
Weight:
Name of Client School or Day Program:
Address:
Unit:
Phone:
Name of Spouse (if applicable):
Vital Status:
What disorder does the Client have?
Ever Been Lost Before?
Where/When:
Were Law Enforcement Authorities Notified?
Agency:
Caregiver (s) Information
Caregiver 1
Name:
Email:
Address:
Unit:
Cellular:
Home Phone:
Work Phone:
Relationship to Client:
Caregiver 2
Name:
Email:
Address:
Unit:
Cellular:
Home Phone:
Work Phone:
Relationship to Client:
Caregiver 3
Name:
Email:
Address:
Unit:
Cellular:
Home Phone:
Work Phone:
Relationship to Client:
Caregiver 4
Name:
Email:
Address:
Unit:
Cellular:
Home Phone:
Work Phone:
Relationship to Client: