Tarpon Springs Police Department

Vacation House Check Program

House Address

Name (First & Last)

Home Phone Number

Cell Phone Number

Departure Date

Return Date

In case of an emergency, where can you be reached?

Phone Number

Address

Does anyone have keys to your house while you are away?

If yes, who? (First & Last Name)

Address

Home Phone Number

Cell Phone Number

Will anyone be working on the premises during your absence?

If yes, who?

Will any cars be parked in the driveway?

Short answer

If more space is needed, use comments box below.

Are there any dogs on the premises?

If yes, are they inside or outside?

Are there any other animals?

If yes, what type of animal?

Will lights be left on inside?

On timers?

Will lights be left on outside?

On timers?

Will TV or radio be left on?

On timers?

Do you have an alarm system?

Does the person with keys know the code?

Comments/Notes

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I am submitting this request to notify the Tarpon Springs Police Department that I will be out of town and my home will be unoccupied for the time period listed above. I agree that I will immediately notify the Tarpon Springs Police Department of my return in order for this vacation check request to be cancelled. I also give permission for members of the Tarpon Springs Police Department to enter onto my property to conduct these checks of my home and if necessary, to enter the premises in the event of an emergency, open door/window, or some other exigent circumstance. I understand that members of the Tarpon Springs Police Department will make checks of my residence and exercise due diligence to prevent crime and insure that my property is secure. I also understand that no measure can always be totally effective and agree to hold the Tarpon Springs Police Department harmless in the event of circumstances beyond their control, which results in damage to or loss of my property.

Check to Agree

Signed by

Date Signed

By clicking the check box above and by entering your name and date on this web form, constitutes an affirmation under oath that you are authorized to make such request and are the legal resident/property owner of the above listed address.