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

Date of Departure

Time of Departure

Date of Return

Time of Return

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

Name

Home Phone

Cell Phone

Email

Do you have an alarm service?

Yes
No

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

Will the lights be on?

No
Yes - Interior
Yes - Exterior

Are the lights on timers?

No
Yes - Interior
Yes - Exterior

Will the mail/newspapers be stopped?

No
Yes - Mail
Yes - Newspapers

Doors and windows locked?

Yes
No

Are there pets around the residence?

No
Yes - Interior
Yes - Exterior

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.

Will anyone be around the home?

Yes
No

If yes, who?

Where can we reach you?

Location (Include address, city, state, zip)

Phone

Local Emergency Contact Information

Name

Phone

Does emergency contact have a key to residence?

Yes
No

Comments

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.

I have read and understood the release and agree to its provisions.
I do not agree to the provisions of the release.

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