EmailMe Form - Jermyn Police Department Vacant House Check Form

Name *
First Last
Date
MM / DD / YYYY
Phone
### - ### - ####
Email
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code
Date Departing *
MM / DD / YYYY
Date Returning *
MM / DD / YYYY
Primary Emergency Contact
First Last
Primary Emergency Contact Phone #
### - ### - ####
Secondary Emergency Contact
First Last
Secondary Emergency Contact Phone #
### - ### - ####
Description of House
Check All That Apply
Someone Will Be Checking on the Property
I Will Be Away for Longer Than 30 Days
Who is Authorized On The Property?
Please Include Vehicle Descriptions/License Plate Info and Scheduled Time on Property for Authorized Visitors.
Are You Leaving Any Vehicles In The Driveway?
Please Describe
Are You Leaving Any Vehicles In The Garage?
Please Describe
Check All That Apply
Outside Lights
Timers on Outside Lights
Home Security System/Alarm
Alarm Type, If Applicable
Alarm Company Name
Alarm Company Phone
### - ### - ####
I Agree to Authorize Members of the Jermyn Police Department to be Present on My Property and Enter My Residence Should an Emergency Be Discovered. *
I Agree