Hazlet Township Police Department

Residential Vacation Check Form

Full Name

First Name

Last Name

Full Address

Street Address

City

State

Zip

Email

Emergency Contact/Key Holder Name

First Name

Last Name

Emergency Contact/Key Holder Phone Number

Emergency Contact/Key Holder Address

Street Address

City

State

Zip

Emergency Contact/Key Holder 2

First Name

Last Name

Emergency Contact/Key Holder 2 Phone Number

Emergency Contact/Key Holder 2 Address

Street Address

City

State

Zip

Property Information

Alarm Company Information

Company name

Phone Number

Lights

On

Off

If Lights on- Which rooms?

Exterior Lights?

Motion

Timer

On Continuously

Off

Pets home?

Yes

No

How many? What Kind?

Who is caring for them?

Mail?

Stopped

Delivered

Being Picked up

By who?

Vehicles left at residence:

Other persons permitted on property:

Departure Date

Date Picker

Date of Return

Date Picker

Additional Information

disregard this