2. 
3. SAFE PLACE Sign Up Form

   Signing up to become a participant in the WPD SAFE PLACE Initiative is easy, FREE, open to participants inside the city of Woodland. Participation is restricted to specific entities such as Businesses and/or Corporations, Social Service Organizations, and Government Agencies. Due to safety concerns, this program is NOT designed, or authorized for individual and/or residential use.

   Prior to submitting your application, you must read and acknowledge the training portion of this document (below). Not understanding your responsibilities when participating in the WPD SAFE PLACE Initiative will have a negative impact on your business, organization, government, and most importantly, the victims of these crimes.

   To apply to be a partner in the SAFE PLACE program complete this application form.

   (Separate applications are required for each address)

5. Organization Name*
7. Address*
9. City*
10. State*
11. Zip Code*
13. Mailing Address (if different from above)
15. City
16. State
17. Zip Code
19. Last Name of Person Requesting*
20. First Name*
22. Phone*
23. E-Mail Address*
25. Training

    NOTE: YOU MUST READ AND ACKNOWLEDGE THE FOLLOWING TRAINING REQUIREMENTS:

    Anyone requesting WPD SAFE PLACE decals to display on their premises MUST agree to train their current and future employees, volunteers and staff of the following two requirements:

    If a victim of ANY crime (especially a hate crime) enters the premise requesting assistance, you, or your staff will:

    • Call 911 Immediately, AND
    • Allow the victim to remain on the premises until police arrive

    Additional training materials will be sent along with your decal.

27. Placement of Decals

    Once you receive your WPD SAFE PLACE decal, you must place it at the front entrance of your establishment. The placement location of the decal should be readily visible to the public from the sidewalk. Most establishments place the decal on their glass doors, or windows, 4’-6’ up from the ground, so that the victims of crime who may be running by can easily see the decal and recognize the symbolism and messaging.

29. Electronic Signature Agreement*

    I have read and understand the above training requirements and agree to abide by them. 

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
31. Electronic Signature*
Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

* indicates a required field