Vacation House Check Request Form

2. 

3. Vacation House Check Request Form
   The vacation check does not guarantee that a burglary or other crime will not occur at the residence, and it is only intended to be a request for our police department representative to check the home periodically, based upon the availability of the officer or citizen volunteer. Consequently, it is highly recommended that you make every effort to safeguard against losses including securing of high value property, proper locking devices, alarm systems, etc. No vacation checks while the homeowner is gone from the home are guaranteed. No further police response or protection is being guaranteed by the vacation check other than the normal police service and protection, which is provided to the general public.

   The vacation check does not guarantee that a burglary or other crime will not occur at the residence, and it is only intended to be a request for our police department representative to check the home periodically, based upon the availability of the officer or citizen volunteer. Consequently, it is highly recommended that you make every effort to safeguard against losses including securing of high value property, proper locking devices, alarm systems, etc. No vacation checks while the homeowner is gone from the home are guaranteed. No further police response or protection is being guaranteed by the vacation check other than the normal police service and protection, which is provided to the general public.

5. Notifications
   Please give us at least 3 days’ notice before you leave. We may need to ask for additional information. If you arrive home early from your vacation, you are responsible to contact the police Department right away.

   Please give us at least 3 days’ notice before you leave. We may need to ask for additional information. If you arrive home early from your vacation, you are responsible to contact the police Department right away.

7. First Name*

8. Last Name*

10. Address*

12. City*

13. State

14. Zip Code

16. Phone Number

17. Cell Phone Number*

19. Email Address*

21. Date & Time Leaving*
    Date & Time Leaving

    Date & Time Leaving

22. Date & Time Returning*
    Date & Time Returning

    Date & Time Returning

24. Emergency Contact Information
    Please list the information of a relative, friend or neighbor that we can contact in the event we are not able to reach you.

    Please list the information of a relative, friend or neighbor that we can contact in the event we are not able to reach you.

26. First & Last Name*

27. Email Address

29. Address

31. City

32. State

33. Zip Code

35. Phone Number*

36. Cell Phone Number*

38. Are there cars in the driveway?*

    1. Yes
    2. No

39. If yes, please describe the vehicles

    Include as much information as possible: Make, Model, Year, Color, License Plate Number, etc.

41. Do you have interior lights left on a timer?

    1. Yes
    2. No

42. Are you exterior lights left on a timer?

    1. Yes
    2. No

43. If yes to lights being on a timer, please describe

45. Do you have Surveillance Cameras?

    1. Yes
    2. No

46. Do you have an operational alarm system?

    1. Yes
    2. No

47. If yes to cameras and/or alarm system, please describe:

49. Will animals be left at your residence while you are away?

    If you will have any animals at your home while you are away, please describe them, where they will be and the name and phone number of the person will be caring for them regularly.

51. Release of Liability
    I release the city of Woodland Police Department from any liability if my home should happen to be burglarized or suffer any damage during my absence. I am aware that this service is contingent on the availability of volunteer//officer personnel.

    I release the city of Woodland Police Department from any liability if my home should happen to be burglarized or suffer any damage during my absence. I am aware that this service is contingent on the availability of volunteer//officer personnel.

53. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
55. Electronic Signature*

56. Today's Date *
    Today's Date

Leave This Blank:


58. 1. Receive an email copy of this form.
59. Email address

    This field is not part of the form submission.

60. Submit

* indicates a required field