2. BLAIR POLICE DEPARTMENT

   VACATION WATCH REQUEST FORM

4. INSTRUCTIONS

   Please complete form with requested information in request extra patrol around your residence while on vacation.  Please contact our office at 402-426-4747 with any questions or to cancel a submitted request.  

6. NOTE

   If for some reason you do not leave on time or you return early, please notify us to have the vacation watch stopped so that law enforcement officers do not startle you during the checks.

8. First Name*
9. Last Name*
11. Address1*
13. Address2
15. City*
16. State*
17. Zip*
19. Phone #*
20. Email
22. Emergency Contact*
23. Emergency Contact Number*
25. Date/Time Leaving*
    Date/Time Leaving

    Date/Time Leaving
26. Date/Time Returning*
    Date/Time Returning

    Date/Time Returning
28. Are there pets in the house?*

    1. Yes
    2. No
29. Does the house have an alarm?*

    1. Yes
    2. No
30. Did you leave music playing?*

    1. Yes
    2. No
31. Are there broken windows?*

    1. Yes
    2. No
33. If Yes, What kind?
34. Notes
35. Notes
36. If so, where/what?
38. Were vehicles left in the driveway?*

    1. Yes
    2. No
39. If yes, what make/model?
41. Will someone be checking on the residence?*

    1. Yes
    2. No
42. If yes, who?
44. Other Details, if necessary
Leave This Blank:


46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit

* indicates a required field