Full middle name required
If known & for emergency contact only
Examples: 1234 Any St, Yuma, AZ or Cruise ship name, or China, etc.
License plate, Make, Model, Color
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.
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