This form is used to notify the Police Department of your upcoming vacation. The Police Department cannot guarantee that we will be able to check your residence at specific times or dates, but we will make every effort to make as many checks on your residence as time and workload allow.

If you need a PDF form, please click here

If you return early from your vacation, please call 817-427-7191

Resident Information: * indicates required information

*Email:

*Name:

*Address:

*Phone Number:
(xxx-xxx-xxxx)  

Away phone:
(Where you can be reached while away.)  

*Date & Departure Time:
(mm/dd/yy)

Date & Return Time:
(mm/dd/yy)

(Notify us immediately if departure or return times change)

Local Emergency Contact:

Name:

Phone Number:

Address:

Additional Information:

Have Keys Been Left with Anyone? Yes   No

Name:

Phone:

Address:

Equipped With Burglar Alarm? Yes   No

Name:

Phone:

Lights Left On:

Timer?: Yes   No

Dogs Left in House or Yard? Yes   No

Vehicles Left on Property (DO NOT INCLUDE VEHICLES IN GARAGE):

1:

Color:

Make:

Lic. #:

Location:

2:

Color:

Make:

Lic. #:

Location:

3:

Color:

Make:

Lic. #:

Location:

Additional Message: