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Vacation House Check Request Form

2. Vacation House Checks Are Free of Charge
   If you are leaving town or going to be out of your home for an extended period of time, feel at ease knowing your home and belongings are safe. After you sign up, Torrington Police Officers will check on your home every day.
4. Name*
6. Address*
8. City*
9. State*
10. Zip Code*
12. Phone*
14. Requested duration*
    Requested duration Start Date

    —

    Requested duration End Date
    Choose the date range you are requesting for extra patrol
16. Reason for Request*

    1. Home is Vacant
    2. Vacation
    3. Other
18. Alarm System Present*

    1. Yes
    2. No
20. Are there lights left on?

    1. Yes
    2. No
22. If so, where?
24. Who has keys to the residence?*
26. Persons That Have Access to the Premises*
    Name, address, phone
28. Address You Can Be Reached
30. City
31. State
32. Zip Code
34. Phone Number You Can Be Reached*
Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field