Complete the following information and the police department will conduct physical checks of your home or property while you are on vacation.

Contact Information

Name:*

Address:*

City:

State:

Zip:

Phone Number:*

Email Address:

Vacation Information

Date Leaving:*

Date Returning:*

Do you have any lights on?*

Select One Yes No

Location of Lights:

Any Vehicles in Driveway?*

Select One Yes No

Vehicle Descriptions:

Emergency Contact Information

Name:*

Address:*

Phone Number:*

Does Emergency
Contact Have Key?*

Authorization Code or Phrase:
(Will be asked for upon return)

Miscellaneous Information