WHPD Vacation House Watch Request
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| Last Name
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| First Name
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| Middle Initial
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| If you have no middle initial, enter "none"
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| Date of Birth
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| DD/MM/YYYY
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| Contact Address
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| Street Address
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| Address Line 2
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| City
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| State / Province / Region
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| Postal / Zip Code
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| Country
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| Primary Phone
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| Primary Phone Type
| Home Cell Other
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| Secondary Phone
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| Secondary Phone Type
| Home Cell Other
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| Email
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| House Watch Address is >
| Same as Above Different (provide below)
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| House Watch Address if different than Contact Address
| MUST BE A WINTHROP HARBOR ADDRESS
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| Type of Residence
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| Single Family Duplex or Apartment
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| Date Leaving
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| Please include an approximate time
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| Date Returning
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| Please include an approximate time
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| Will lights be on?
| Yes No
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| Lights on timers?
| Yes No
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| Windows locked?
| Yes No
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| Drapes closed?
| Yes No
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| Mail stopped?
| Yes No
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| Newspaper stopped?
| Yes No
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| Neighbors informed?
| Yes No
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| House key available?
| Yes No
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| If a house key is available, who is the key-holder? (enter full name)
| Last, First, M.I.
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| Key-holder's Phone:
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| Pet(s) present?
| Yes No
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| If pets will be present, please list type(s)
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| If pets will be present, name and number of caretaker
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VEHICLE INFORMATION:
Your vehicles that will be present while you are away.
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| Vehicle-1 Plate #
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| Vehicle-1 Year
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| Vehicle-1 Make
| Ford, Chevy, Chrysler...
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| Vehicle-1 Model
| Escort, Impala, Sebring...
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| Vehicle-1 Color
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| Vehicle-1 Location
| Driveway Garage
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| Vehicle-2 Plate #
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| Vehicle-2 Year
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| Vehicle-2 Make
| Ford, Chevy, Chrysler...
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| Vehicle-2 Model
| Escort, Impala, Sebring...
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| Vehicle-2 Color
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| Vehicle-2 Location
| Driveway Garage
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| Vehicle-3 Plate #
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| Vehicle-3 Year
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| Vehicle-3 Make
| Ford, Chevy, Chrysler...
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| Vehicle-3 Model
| Escort, Impala, Sebring...
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| Vehicle-3 Color
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| Vehicle-3 Location
| Driveway Garage
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ALARM SYSTEM INFORMATION
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| Is there an alarm system?
| YES NO
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| If YES, please check all that apply:
| Silent Audible Monitored Security Only Fire Only Security & Fire Other
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PEOPLE WHO MAY BE PRESENT
List any people that are authorized to be inside your home while you are away.
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| Name
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| Prefix
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| First
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| Last
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| Suffix
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| Name
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| Prefix
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| First
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| Last
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| Suffix
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| Name
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| Prefix
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| First
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| Last
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| Suffix
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EMERGENCY CONTACT INFORMATION
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| Who should we call in the event of an emergency?
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| Name of 1st emergency contact
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| Prefix
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| First
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| Last
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| Suffix
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| Phone Number
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| Name of 2nd emergency contact
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| Prefix
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| First
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| Last
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| Suffix
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| Phone Number
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ADDITIONAL INFORMATION
Please provide any additional information, comments or questions here.
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IMPORTANT:
By submitting a request for the Vacation House Watch Program, you authorize the Winthrop Harbor Police Department to enter your residence while you are absent, in the event that a door or window is found to be open, or for any other circumstance as deemed necessary by an Officer conducting the house watch. You understand that the Police Department will conduct periodic house watch checks on your residence, at various times of the day and night, during the specified period. You further understand that the Police Department is not responsible for loss or damage to your residence, vehicles or personal property due to burglaries and/or other events which may occur during your absence. You also understand that during winter months your sidewalks must be shoveled (by others) or the house watch checks may not be conducted. You understand that you must call the Police Department at 847-872-2131 when you return to your residence.
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| AGREEMENT
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| Enter your full name here as agreement to the above statements.
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SUBMIT REQUEST
When finished entering your request information, complete the Image Verification and click the Submit button below.
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