*Name of Person Making this Request

*Address to be Checked

*Best Phone Number While You Are Away

Alternate Phone Number and/or Email Address

*Departure Date

*Expected Return Date

*Primary Emergency Contact Name Who should we contact in case of an emergency, if we cannot reach you?

*Vehicle(s) and Plate(s) Please include what vehicle(s) this person will be driving, including license plate, if known.

*Main Phone Number

*Alternate Phone Number

Secondary Emergency Contact Name

Vehicle(s) and Plate(s) Please include what vehicle(s) this person will be driving, including license plate, if known.

Main Phone Number

Alternate Phone Number

If you have a pool service, what is the name of the company and what days are they on site?

If you have a lawn service, what is the name of the company and what days are they on site?

If you have a cleaning service, what is the name of the company and what days are they on site?

If you have a monitored alarm system, what is the name of the company?

Phone Number for Alarm Monitoring Company

*Will any lights be left on (interior or exterior)?

If lights are left on, what areas of the home should be lit at night? Are they on a timer (e.g., would it be expected that they would be on during some hours but not others?) Please include as many details as possible. For example, "The flood light above the garage is on a motion sensor" or "If you are facing the house from the street, the kitchen is the second window from the right on the first floor and is on a timer. Lights should be on from 6:00 p.m. to 11:00 p.m."

*Have you stopped mail and newspaper delivery?

If no, who will be checking these? Please provide name(s) and state issued ID number, if possible.

*Will any animals be present in your yard or residence that might hamper response by either the Police or Fire Department personnel in case of an emergency? Please list type and number of animals, including breed of any dogs and/or any venomous or otherwise potentially dangerous pets.

Other information or special instructions to our officers: