Vacation Check Request

If you live within the Collierville Town limits and you would like the Collierville Police Department to conduct routine security checks of your residence while you are away for an extended period of time, please notify the department by submitting the following form. It may take up to 48 hours to process this request. If you have any difficulties in completing this form or question if it was submitted properly, please call 457-2500 to have department staff complete a request for you.

Address

Invalid Input
Date of Departure (Select from calendar below)


Invalid Input
Time of Departure

Invalid Input
Date of Return (Select from calendar below) (*)


Invalid Input


Invalid Input

Please call (901) 457-2562 if you return earlier than indicated.

Name

Invalid Input
Phone

Invalid Input
Cell Phone

Invalid Input
Email

Invalid Input
Do you have an alarm service?

Invalid Input
If yes, provide the company's name and phone number.

Invalid Input
Will the lights be on?

Invalid Input
Are the lights on timers?

Invalid Input
Will the mail/newspapers be stopped?

Invalid Input
Doors and windows locked?

Invalid Input
Are there pets around the residence? (*)

Invalid Input
Describe any vehicles on the outside of the property. Include make, model, color, and registration if possible. Indicate if the vehicle will be concealed in a garage.

Invalid Input
Will anyone be around the home?

Invalid Input
If yes, who?

Invalid Input

Where can we reach you?

Location (Include address, city, state, zip)

Invalid Input
Phone

Invalid Input
Does local contact have a key to residence?

Invalid Input
Name of Local Contact

Invalid Input
Local Contact Phone Number

Invalid Input
Comments

Invalid Input

Please read the following statement before submitting this form. The Collierville Police Department, per your request, will attempt to check your residence periodically. Neither the Town of Collierville, nor the Collierville Police Department assume any liability in the event of theft, loss or damage to personal or real property in or around your residence. By submitting this form, it is understood and agreed that neither the Town of Collierville or the Collierville Police Department assumes any liability with the "Vacation House Check." The resident, by accepting the "Vacation House Check," and by execution of this request understands and agrees to the provisions of this release.

Release agreement (*)

Invalid Input

The Collierville Police Department will not consider any requests without agreement to the release provisions listed above.

Please type in what you see (*)

Invalid Input