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2. 

4. Thank you for your interest in the Safe Place Program. This program leans on partnerships with Island City businesses that volunteer to participate. As a business partner, you will be trained on how to provide a haven for crime victims, how to sensitively communicate with victims, and how to contact the WMPD for assistance.

   A member of the WMPD team will reach out following submission of this form with next steps including a site visit and welcome packet.

6. * Indicates a Required Field
8. Business Name*
10. FEIN Number

    (Optional)

12. Name*
13. Title*
15. Phone Number*
16. Email*
18. Address1*
20. Address2
22. City*
23. State*
24. Zip*
26. Safe Place Participation Agreement*

    1. I Agree

    I understand the Safe Place Program is a voluntary program, and I attest the information provided herein is truthful and accurate. Furthermore, I agree to provide a safe haven for all crime victims until help has arrived.

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28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit Submit and Print

* indicates a required field