Vacation House Check Form
Clearcreek Township Police Department
Email
*
example@example.com
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Departure Date
*
-
Month
-
Day
Year
Date
Departure Time
*
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Return Date
*
-
Month
-
Day
Year
Date
Return Time
*
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Emergency Contact Name
*
First Name
Last Name
Emergency Phone Number
*
-
Area Code
Phone Number
Will the emergency contact be entering your home while you are away?
*
Yes
No
Will anyone be getting the mail?
*
Yes
No
Will anyone be doing yard work?
*
Yes
No
Do you have an alarm?
*
Yes
No
Will the alarm be ON?
*
Yes
No
Alarm Company Name:
*
Alarm Company Phone Number
*
-
Area Code
Phone Number
Will there be any lights on inside
*
Yes
No
On Timers
Will there be any lights on outside
*
Yes
No
On Timers
Do you have pets?
*
Yes
No
Where are the pets?
Inside
Oustide
Will there be any vehicles in the driveway?
*
Yes
No
Make and color of vehicles
Any additional information?
Submit
Should be Empty: