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House Watch Form

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Steps

1. Personal Information This section is complete This section is incomplete
2. Residence Information This section is complete This section is incomplete

Personal Information

Melissa Police Department
Duane A. Smith, Chief
Date Leaving and Returning*
Date Leaving and Returning Start Date
—
Date Leaving and Returning End Date
First Name*
Last Name*
Address*
City*
State*
Zip Code*
Phone Number*
Email Address*
Emergency Contact 1:*
Contact Number:*
Emergency Contact 2:
Contact Number:
Continue

Residence Information

Description of residence:*
Will keys be left with anyone?*
1. Yes
1. No
First Name
Last Name
Phone Number
Address
City
State
Zip Code
Will anyone else be going in and out of the house? *
Please list names and phone numbers of people that will be in and out of house
Will you be leaving your lights on?*
1. Yes
1. No
Where are your lights going to be on?
Are your lights on a timer?*
1. Yes
1. No
What time will your lights be on?
Will Cats or Dogs be left at the house?*
1. Yes
1. No
Where will animals be left?
1. Inside
1. Oustide
Will you have anyone doing yard work?*
1. Yes
1. No
Who will it be?
Will you be stopping newspaper or mail delivery?*
1. Yes
1. No
Do you have a home alarm?*
1. Yes
1. No
Name of Alarm Company
Will any vehicles be left at the resdence?*
1. Yes
1. No
Where will they be left?
1. Outside
1. Garage
Year
Make
Model
License Plate #
Year
Make
Model
License Plate #
Year
Make
Model
License Plate #
*Should you return earlier than expected, please notify us so we may cancel the watch.