Vacation House Check Request

This form is to be used when you are leaving town, and would like the 
police department to monitor your home.

This is not an official vacation house check form.  This information will be used to contact you prior to your departure.  Please allow a minimum of three (3) working days to be contacted by an officer.


Name   ( first, middle, last )
Street Address
Zip/Postal Code
Home Phone
Email Address

Date to Depart
Date to Return

Do you have an alarm?
Yes         No

Name of Alarm Company:

Are there lights on a timer?
Yes         No


Please provide information in the space below in reference to type of lights left on, keys that are left with a contact person and any cars left outside.  Please include a list of firearms that may be in your residence.