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Home Vacation Check Application

  1. I have read and understand the Home Vacation Check description and requirements.*

  2. RESIDENT INFORMATION

  3. Full middle name required

  4. Example: 01/14/1982

  5. If known & for emergency contact only

  6. Will you be monitoring this email while on vacation?

  7. Examples: 1234 Any St, Yuma, AZ or Cruise ship name, or China, etc.

  8. This service is provided for those who are gone a min. of 5 days and a max. of 90 days (or 3 months). Applications MUST be submitted at least 7 days BEFORE departure.

  9. Local Emergency Contact (key holder) is required.

  10. Alarm?

  11. Audible or Silent?

  12. Will the alarm activate if the doors are firmly checked?

  13. Is the alarm monitored by an alarm company?

  14. Can your emergency contact deactivate your alarm?

  15. Will you have lights, radio or tv left on timers?

  16. Do you want your backyard checked?

  17. Is this a gated community?

  18. We strongly recommend you stop your newspaper and mail service while you are gone.

  19. Will you be leaving vehicle(s), on your property, while you are gone?

  20. License plate, Make, Model, Color

  21. Will you be leaving a 2nd vehicle?

  22. License plate, Make, Model, Color

  23. Will you be leaving a 3rd vehicle?

  24. License plate, Make, Model, Color

  25. In addition to the "Emergency Contact", the following people are authorized to be on/in the property. Examples: Maid service, lawn care, pet care, etc.

  26. Required:*

    By submitting this form, I hereby authorize house checks to be conducted in my absence. I understand and acknowledge that a request for a house check pursuant to this program does not guarantee the safety or security of my property. I further acknowledge that the Eugene Police Department is in no way responsible for my property in my absence and that Seniors on Patrol and Eugene Police may visually and/or physically inspect my premises during their patrols.

  27. Leave This Blank:

  28. This field is not part of the form submission.