Manchester Police Department 

Senior Outreach Service 

Recognizing that approximately twenty-two percent of our citizens are age 60 and older, the Manchester Police Department is committed to working in partnership with seniors in our community to address their needs and improve their quality of life. 

Through participation in the Senior Outreach Service Program, a representative of the Manchester Police Department will contact enrolled participants on a weekly basis to check on their well-being and address any concerns they may have. If contact cannot be established with the participant, the designated emergency contact person will be notified. If circumstances warrant further assistance, a police officer may be dispatched to conduct an in-person welfare check. 

To enroll in the program, a senior citizen or a family member must complete the participation form. Once the application is received, a department representative will contact the participant to schedule an introductory meeting. 

Eligibility Requirements 

To qualify for this free program, applicants must: 

• Be a resident of the City of Manchester 

• Be 60 years of age or older and/or disabled 

• Complete and submit the participation form 

 

The Manchester Police Department is dedicated to supporting the safety, independence, and well-being of our senior citizens and looks forward to serving those who participate in this program. 

 Please complete form:

City of Manchester, Tennessee

Manchester Police Department – Senior Outreach Service

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City of Manchester, Tennessee

Manchester Police Department – Senior Outreach Service

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Participant Information

Full Name:

Date of Birth:

Address:

City:

State:

ZIP Code:

Home Phone:

Emergency Contact #1

Full Name:

Relationship:

Address:

City:

State:

ZIP Code:

Home Phone:

Work Phone:

Cell/Alt Phone:

Emergency Contact #2

Full Name:

Relationship:

Address:

City:

State:

ZIP Code:

Home Phone:

Work Phone:

Cell/Alt Phone:

Key Location & Additional Details

Extra Key Available?

Yes No

Location of Extra Key:

Additional Details:

Authorization

Digital Signature (Type Full Name):

Date:

Submit Application

I, the undersigned, freely and voluntarily give permission to the Manchester Police Department and/or their agents, representatives, principals, and employees, to 
enter my residence for the purpose of checking on the well-being of myself and/or my family.  Upon the circumstance that Officers of the Manchester Police 
Department reasonably believe that an emergency exists and a key holder cannot respond in time to reasonably mitigate the emergency, I agree to hold harmless 
the City of Manchester for any and all damages incurred to any personal and/or real property if entry into my residence is forced.  I further agree to waive any and 
all claims I have or may have, whether known or unknown, arising out of my voluntary enrollment into this Program.