Operation Reassurance Informational Form

  • Operation Reassurance is a mission that the Village and Town of Mukwonago Police Departments take very seriously. We want the citizens of our community to feel safe and to be safe. One step in accomplishing this is by the Village and Town Police Departments providing this special service to you.
    Although you may choose to become a member of our Operation Reassurance program for as long as you wish, we do have some important guidelines that you must follow to ensure that we can provide you with the best service possible.
    1. When you sign up for Operation Reassurance, you are making a commitment that you will call in every day during the time frame you choose below. For example, if you choose to call us during the 9 AM to 11 AM window, then you will be expected to call every day of the week during this time, UNLESS you contact us and let us know that you will not be calling in for some reason. For example, maybe you have scheduled a doctor's appointment or a vacation during your scheduled time. That's fine, just let us know that you will not be calling in. Otherwise, if we do not hear from you, we will assume there could be a problem and we will send someone to your home to check on you.
    2. If you fail to call in more than five (5) times, we may discontinue offering this program to you.
  • Contact Information

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  • Emergency Contact Information


  • Legal Next of Kin


  • Medical Information

  • Miscellaneous Infromation

  • If yes, please provide the following vehicle information.


  • Download the Medical Emergency Information Form
    (We recommend that you download, complete and post this information on your refrigerator. You could also copy this form and carry it in your wallet/purse)

  • All information if kept confidential and is only used in case of an emergency.


  • Once you have submitted this form, a member of the Village Police Department or the Town Police Department will meet with you to go over procedures.

    By signing and dating this agreement, I am acknowledging my responsibility to call in every day during my time window.


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