Crown Point Police Department

Vacation Check Request

I would like the Crown Point Police Department to make extra patrols of my residence/business during my absence. I understand that such checks will be made subject to the availability of manpower and that the Crown Point Police Department in no way assumes responsibility for the security of my premises. I understand that the Crown Point Police Department can only check the exterior of the building and secure exterior areas will not be checked.

By Checking the box next to "YES" and typing your name in the box below you verify that the above written are your wishes

YES
NO

Please fill out the following information:

Date Leaving: Date Returning:

First Name: Last Name:

Your Address: Apt Number:

Business Business Name:

Business Address:

Phone Number at Premise:

Person Who Can Respond in an Emergency

Name:

Telephone Number (Day):

Telephone Number (Evening):

Do they have a key? Yes No

Your Destination(s)

Address or City, State:

Name of Hotel or Resort (If Applicable):

Name Regsitered (If Applicable):

Telephone Number (Destination):

Telephone Number (Other):

Route / Means of travel:

Premise Information

Does location have an alarm? Yes No

Alarm Company:

Phone Number:

Are any lights, televisions, radios, or other electronics on timers? Yes No

If Yes, explain:

Are there any animals on premises? Yes No

If Yes, is/are the animal(s) caged? Yes No

Type of animal(s)/location:

Person Responsible for care:

Telephone Number (Day):

Telephone Number (Evening):

Anyone besides emergency contact authorized to be at address? Yes No

If yes fill in below: Name, Vehicle Description, Reason. If more than 2, enter in "Additional Comments"

Person 1:

Person 2:

Additional Comments

Have a safe and enjoyable time!

ONLY PRESS "SEND" ONCE!

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