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2. General Information

4. Last Name*
5. First Name*
6. Phone Number*
8. Email Address*
9. Home Address*
11. Date / Time Leaving*
12. Date / Time Returning*
13. Date / Time Reported*
15. Light(s) on?*

    1. Yes
    2. No
16. Will any pets be left in the residence?*

    1. Yes
    2. No
17. Number of pets
18. Pet(s) Location

    1. Inside
    2. Ouside
    3. Inside and outside
20. Pet(s) Description*

    If not applicable, please enter "N/A"

22. Do you have an alarm system?*

    1. Yes
    2. No
23. Alarm Company Name
24. Alarm Company Phone
25. Alarm Company Address

29. Emergency Contacts

    Include information for who we should contact if we can't get ahold of you.

31. Last, First Name*

    Primary Emergency Contact

32. Date of birth*

    Primary Emergency Contact

    
    

33. Race*

    Primary Emergency Contact

35. Sex*

    Primary Emergency Contact

36. Email Address*

    Primary Emergency Contact

37. Phone Number*

    Primary Emergency Contact

39. Last, First Name

    Secondary Emergency Contact

40. Date of birth

    Secondary Emergency Contact

41. Race

    Secondary Emergency Contact

43. Sex

    Secondary Emergency Contact

44. Email Address

    Secondary Emergency Contact

45. Phone Number

    Secondary Emergency Contact

49. Vehicle Listings

    Include information for all vehicles that will be left in the driveway or on the property

51. License Plate Number(s)
52. License Plate(s) State
53. How many vehicles will be left in the driveway or on the property?
55. Vehicle Make, Model, Color, Year(s)

    Example(s):
    Ford Escape, White, 2015
    Toyota 4 Runner, Dark Green, 2001

56. Other vehicle description information
60. Narrative

    Include any other information you wan our team to know while you're away.

62. Acknowledgement

    By signing this form, I request and give permission for officers, staff, and volunteers of the Ventura Police Department to enter the above listed property at any time, day or night. I also acknowledge that Vacation Checks are conducted based on availability and there is no guarantee my home will be checked daily. 

    Please note - This service is not for vacant properties, residences where someone is staying at the property, or for homes being fumigated.

64. Your Full Name*

    By entering your name here, you agree your electronic signature is the legal equivalent of your manual signature on this form.

    
    

65. Date & Time of Electronic Signature*
    Date & Time of Electronic Signature

    Date & Time of Electronic Signature
Leave This Blank:


67. 1. Receive an email copy of this form.
68. Email address

    This field is not part of the form submission.

69. Submit

* indicates a required field