Form Center

By signing in or creating an account, some fields will auto-populate with your information.

Waukee Safe House Program Application

  1. Waukee Safe House Program Details and Guidelines
    The Waukee Safe House Program was created to provide homes throughout the City to be a safe refuge for children who feel they are in danger. Waukee Safe House volunteers are concerned citizens who have demonstrated a desire to accept a shared responsibility for the well-being of children in their neighborhoods. A Waukee Safe House is most effective when an adult is home between the hours of 7:30 a.m. and 4:30 p.m.; this includes one hour before and one hour after school. However, inability to meet this recommendation does NOT prohibit participation.

    To safeguard the integrity of the program, Waukee Safe House participants are required to submit to a background check. After completion of a satisfactory background check, the Safe House volunteer will receive a distinctive placard for display in a conspicuous location, identifying his/her residence or business as a recognized Waukee Safe House.

    Waukee Safe House participants should:
    • Telephone appropriate authorities for help.
    • Reassure and assist the child.
    • Assist children if there is a medical emergency by dialing 911.
    • Report crime and suspicious activities to law enforcement.
    • Return the Waukee Safe House sign to the Waukee Police Department if;
    -Moving out of the City of Waukee (please notify us of change of address if you are staying in Waukee).
    -A member of the household becomes ineligible to continue.

    Safe House participants are NOT required to:
    • Provide first aid or give medication.
    • Act as a guard, enforce laws or guarantee safety.
    • Provide toilet facilities, food or beverages.
    • Provide a place to “warm up” or “cool down”.

    An application for the Waukee Safe House Program may be rejected if anyone in the household has:
    • Been convicted of a felony or a serious misdemeanor.
    • Violated narcotic drug laws.
    • Has two or more alcohol-related convictions.
    • Violated domestic or child abuse laws.
    • Been convicted of any charge involving an offense against a child.
    • A record of law enforcement responses to the residence.
    • A history of behavior dangerous to self and/or others.

    The Waukee Police Department may, beyond these guidelines, use their own discretion in determining whether to accept, reject or renew an application.
  2. Safe House Applicant Information
  3. Waukee, IA 50263
  4. Household Members
    Provide the names and birthdates below for all persons residing in your household. The Waukee Police Department will likely circle back asking for Social Security Numbers, but for your protection, we will not ask for those on this online form.
  5. By typing my name here, I agree that I have read and understand the Safe House guidelines and certify that all the information given is correct.
  6. Leave This Blank:

  7. This field is not part of the form submission.