Request House Check

2. House Check Information / Requirements
   The maximum time frame for a watch or check is one month or 30 days. If you will be gone longer, it is your obligation to provide the police department with an updated form.<br><br> If you will not be away from your home, explain in additional information box below why you are requesting a house check.<br><br> Please provide us one weeks notice prior to your departure for you vacation / leave.

   The maximum time frame for a watch or check is one month or 30 days. If you will be gone longer, it is your obligation to provide the police department with an updated form.
   
   If you will not be away from your home, explain in additional information box below why you are requesting a house check.
   
   Please provide us one weeks notice prior to your departure for you vacation / leave.

4. Name*

5. Email Address

7. Address*

9. City*

10. State*

11. Zip Code*

13. Primary Phone Number*

14. Cell Phone Number

15. Another Number we can reach you at while you're gone:

17. Departure Date*
    Departure Date

18. Return Date*
    Return Date

    No longer than 30 days from Departure Date

22. Does your home have an alarm system?

    1. Yes

    1. No

23. If "Yes" Alarm Company Name

24. Alarm Company Phone Number

28. Will someone be checking the home while you are away?

    1. Yes

    1. No

30. Name: Emergency Contact Number 1 (EC1)

31. Name: Emergency Contact Number 2 (EC2)

33. EC1 Primary Phone Number

34. EC2 Primary Phone Number

36. EC1 Cell Phone Number

37. EC2 Cell Phone Number

39. EC 1Relationship

    1. Relative

    1. Neighbor

    1. Friend

40. EC2 Relationship

    1. Relative

    1. Neighbor

    1. Friend

42. Does EC1 have a Key?

    1. Yes

    1. No

43. Does EC2 have a key?

    1. Yes

    1. No

47. Lights on in home?

    1. Yes

    1. No

49. Location of lights:

    1. Bedrooms
    2. Bathrooms

    1. Kitchen
    2. Living Room

    1. Other Locations

    Describe other locations in following field.

50. Describe other locations where lights are on:

54. List the vehicles in the garage:

    Color, make, model, license plate, etc.

55. Vehicles in the driveway

    Color, make, model, license plate, etc.

59. Any additional information that we may need:

Leave This Blank:


61. 1. Receive an email copy of this form.
62. Email address

    This field is not part of the form submission.

63. Submit

* indicates a required field