Senior Safety Alert

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Homebound Senior Information

alert notice 2019 Could you care for yourself during an emergency?


The City of Claremont has a program to assist Claremont residents that are homebound and unable to care for themselves during a major emergency. The objective of the program is to locate homebound and special needs residents and check on their safety in such emergencies. If you or a loved one is in need of special assistance please fill out the form below.

The person(s) named on this form will be contacted by the City Case Manager or the Claremont Police Department to verify their willingness to be included in the program and to give them additional information. All names are kept CONFIDENTIAL and used only in the case of an emergency.

 For more information, please call the City Case Manager at (909) 399-5488 ext. 107

Please correct the field(s) marked in red below:

1
Name of homebound resident
 *
2
Claremont Address
 *
3
Telephone Number
 *
4

Mobile Phone Number

5
Name of person submitting form (if not different than homebound resident)
6
Phone number of person submitting form
  1. To receive a copy of your submission, please fill out your email address below and submit.