Please use this form 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. Security house checks will not be performed on a residence that has a house sitter or is being checked by a citizen chosen by the resident.

NOTE: Security house checks are provided while you are away for a minimum of four days and will run a maximum of 30 days. ALL HOUSE CHECKS MUST BE RENEWED AFTER 30 DAYS.

If you return early from vacation, please inform the Police Department at 817-427-7191.

Resident Information

Name:*

Email:*

Address:*

Zip Code:*

Phone:*

Cell:

Vacation Information

Departure Date:*

Return Date:*

Have you left keys with anyone?

Yes

No

If so, who?

Is your home equipped with a burglar alarm?

Yes

No

Are there dogs in the yard?

Yes

No

What room(s) will the lights be on?

Are they on a timer?

Yes

No

Local Emergency Contact

Name:

Phone:

Address:

Vehicles On Property (Do not include vehicles in the garage)

Please include the color, make, license number and location of vehicles on the property:

Is there any additional information the Police Department should know?