Citizens’ Patrol Home Check Request

Your Information

Name *

Address *

Phone Number *

EMail *

A copy of the information you provide will be sent to this address.

Date/Time You Are Leaving *

Leaving Time *

Date/Time You Are Returning *

Returning Time *

Who Will Be Visiting?

Will anyone be visiting to water the plants, feed animals, pick up mail or put out the trash?

Yes

No

Their Name

Their Phone Number

Addl Phone Number / Contact Info

You may enter an additional phone number or contact information for them.

Automobile Description

Dates/Times They Will Be There

Additional Information

Who is designated to pick up packages (name/phone)?

Will the lights, radio, TV, etc. be left on?

Yes

No

Do you have an alarm system?

Yes

No

Who can disengage it (name/phone)?

Emergency Number/Person to Call *

Do Your Neighbors Know That You're Away?

Yes

No

Do They Know That Citizens' Patrol is Checking The Property?

Yes

No

Is there any other information we should be aware of?

Acknowledgment

I hereby request the Fox Island Citizen’s Patrol (“Patrol”) to conduct visual check(s) of the property listed above. I understand that the Patrol is a voluntary citizens association without any full or part-time employees and without any licensed law enforcement personnel; that the Patrol will drive by or check above property when possible, as a courtesy, without any obligation to do so, to check the property for any suspicious activity at the property; Patrol members are not responsible for picking up packages. Patrol members do not make arrests, do not carry weapons and do not take any enforcement action, while on patrol. The Patrol will report any suspicious activity to the Sheriff’s Department; there is no representation by the Patrol as to frequency of any such house checks. The undersigned holds the Patrol and its members harmless from any loss or damage to the property or the undersigned that may be suffered by the undersigned through any action or lack thereof by the Patrol or its members or any third party.