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2. Name
4. Address
6. Email
7. Phone
9. Departure & Return Dates
   Departure & Return Dates Start Date

   —

   Departure & Return Dates End Date
11. 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 dispatch at 817-556-6060.
13. Have you left keys with anyone?

    1. Yes
    2. No
14. Please provide their name and phone number.
16. Is your home equipped with a burglar alarm?

    1. Yes
    2. No
17. Are there dogs in the yard?

    1. Yes
    2. No
19. Will lights be left on?

    1. Yes
    2. No
20. Are the lights on a timer?

    1. Yes
    2. No
22. Local Emergency Contact Information
24. Name
26. Address
28. Cell
29. Phone
31. Please include the color, make, license plate number, and location of vehicles on the property.
33. Should anyone be at the residence while you are gone?

    1. Yes
    2. No
34. Please provide name, phone, and vehicle.
36. Is there any additional information the Police Department should know?
Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

* indicates a required field