Community Comfort Line - Thomaston, ME

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PARTICIPANT INFORMATION

Full Name *

Date Of Birth

Street Address (Thomaston, ME) *

Primary Phone Number *

Secondary Phone Number (If Applicable)

Email Address (Optional)

Call Preference (Check All That Apply) * Monday (AM)
Monday (PM)
Friday (AM)
Friday (PM)

EMERGENCY CONTACT INFORMATION

Emergency Contact Full Name *

Relationship

Primary Phone Number *

Secondary Phone Number (If Applicable)

WELLNESS CHECK INSTRUCTIONS (OPTIONAL BUT RECOMMENDED)

This information will assist officers if a home wellness check becomes necessary.

Location Of Spare Key (If Applicable)

Entry Instructions

Medical Conditions Officers Should Be Aware Of (Optional)

Other Helpful Notes

PROGRAM PROCESS ACKNOWLEDGEMENT

By signing below, I acknowledge and understand the following:

• I am voluntarily enrolling in the Community Comfort Line program.
• I understand that I will receive one weekly phone call from the Thomaston Police Department between 10:00 AM and 2:00 PM on my selected day.
• If I do not answer the initial call, a second call attempt will be made approximately 30 minutes later.
• If I do not answer the second call attempt, the Thomaston Police Department will contact my listed emergency contact.
• If my safety cannot be confirmed through phone contact or through my emergency contact, officers may conduct an in-person home wellness check.
• I understand that this program is voluntary and may be discontinued at any time at my request.
• I understand that participation does not create a special duty beyond the scope of this program and services are provided in accordance with Maine state law.

I confirm that I am a willing participant in this program.

IF COMPLETED BY FAMILY MEMBER OR REPRESENTATIVE

By checking the box below and typing my name, I certify that the participant listed above is aware of this registration, has voluntarily agreed to participate, and has authorized me to complete this form on their behalf. I understand this electronic acknowledgment is legally binding.

By checking the box below and typing my name, I certify that I am the participant listed above and that I voluntarily consent to participate in this program. I understand that my electronic acknowledgment is legally binding and equivalent to a handwritten signature.

Agreement * I agree to the terms above
I confirm the participant’s consent

Electronic Signature (Typed Legal Name) *

Today's Date *

* - denotes required field

Program Details

Community Comfort Line is a free, voluntary weekly check-in program for senior residents of Thomaston.

Created through a partnership between the Thomaston Police Department and the Thomaston Recreation Department, this program is designed to promote connection, reassurance, and safety.

Participants receive one scheduled phone call each week on either Monday or Friday, typically between 10:00 AM and 2:00 PM. During the call, a member of the Thomaston Police Department will check in to make sure everything is going well.

If a call goes unanswered, a second attempt will be made approximately 30 minutes later. If there is still no response, an emergency contact will be notified. If safety cannot be confirmed, an in-person wellness check may be conducted.

This program is intended to provide peace of mind to seniors and their families while strengthening the sense of care and connection within our community.