WHPD Vacation House Watch Request

Last Name *
First Name *
Middle Initial *
If you have no middle initial, enter "none"
Date of Birth *
DD/MM/YYYY
Contact Address *
Street Address *
Address Line 2
City *
State / Province / Region *
Postal / Zip Code *
Country *
Primary Phone *

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Primary Phone Type
 Home 
 Cell 
 Other 
Secondary Phone

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Secondary Phone Type
 Home 
 Cell 
 Other 
Email *
House Watch Address is >
 Same as Above 
 Different (provide below) 
House Watch Address if different than Contact Address
MUST BE A WINTHROP HARBOR ADDRESS
Type of Residence *
 Single Family 
 Duplex or Apartment 
Date Leaving *

MM
/
DD
/
YYYY

HH
:
MM

AM/PM
Please include an approximate time
Date Returning *

MM
/
DD
/
YYYY

HH
:
MM

AM/PM
Please include an approximate time
Will lights be on?
 Yes 
 No 
Lights on timers?
 Yes 
 No 
Windows locked?
 Yes 
 No 
Drapes closed?
 Yes 
 No 
Mail stopped?
 Yes 
 No 
Newspaper stopped?
 Yes 
 No 
Neighbors informed?
 Yes 
 No 
House key available?
 Yes 
 No 
If a house key is available, who is the key-holder? (enter full name)
Last, First, M.I.
Key-holder's Phone:

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Pet(s) present?
 Yes 
 No 
If pets will be present, please list type(s)
If pets will be present, name and number of caretaker

VEHICLE INFORMATION:

Your vehicles that will be present while you are away.
Vehicle-1 Plate #
Vehicle-1 Year
Vehicle-1 Make
Ford, Chevy, Chrysler...
Vehicle-1 Model
Escort, Impala, Sebring...
Vehicle-1 Color
Vehicle-1 Location
 Driveway 
 Garage 
Vehicle-2 Plate #
Vehicle-2 Year
Vehicle-2 Make
Ford, Chevy, Chrysler...
Vehicle-2 Model
Escort, Impala, Sebring...
Vehicle-2 Color
Vehicle-2 Location
 Driveway 
 Garage 
Vehicle-3 Plate #
Vehicle-3 Year
Vehicle-3 Make
Ford, Chevy, Chrysler...
Vehicle-3 Model
Escort, Impala, Sebring...
Vehicle-3 Color
Vehicle-3 Location
 Driveway 
 Garage 

ALARM SYSTEM INFORMATION

Is there an alarm system?
 YES 
 NO 
If YES, please check all that apply:
 Silent 
 Audible 
 Monitored 
 Security Only 
 Fire Only 
 Security & Fire 
 Other 

PEOPLE WHO MAY BE PRESENT

List any people that are authorized to be inside your home while you are away.
Name
Prefix
First
Last
Suffix
Name
Prefix
First
Last
Suffix
Name
Prefix
First
Last
Suffix

EMERGENCY CONTACT INFORMATION

Who should we call in the event of an emergency? *
Name of 1st emergency contact
Prefix
First
Last
Suffix
Phone Number

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Name of 2nd emergency contact
Prefix
First
Last
Suffix
Phone Number

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ADDITIONAL INFORMATION

Please provide any additional information, comments or questions here.

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.
AGREEMENT *
Enter your full name here as agreement to the above statements.

SUBMIT REQUEST

When finished entering your request information, complete the Image Verification and click the Submit button below.