Form Center

2. Please take or fax to:
   South Heidelberg Township Police Department
   555A Mountain Home Road
   Sinking Spring, PA 19608
   Fax: 610-678-5056
6. First Name
7. Last Name
9. Address
11. City
12. State
13. Zip Code
15. Probable Route of Trip
17. Scheduled Date of Departure
    Scheduled Date of Departure
18. Scheduled Date of Return
    Scheduled Date of Return
19. Type of Premise

    1. Business
    2. Residence
    3. Other
20. Have the keys been left with someone?

    1. Yes
    2. No
22. If Yes, Please List the Name & Address
23. Phone
25. Is this premise alarmed?

    1. Burglar
    2. Fire
    3. Motion
    4. N/A
26. Name of Security Company
27. Phone
29. Will anyone have access to the premises during your absence?

    1. Yes

    1. No
30. If Yes, Please List the Names
32. In case of emergency, who should the Police notify?
33. Are there any lights on, timers, or motion detectors? If so, explain.
35. Is there anything else the police should know relative to this security check?
37. I request a check be made of my premises and I agree to notify you of my return.
38. Date of Request
    Date of Request
40. Disclaimer/Waiver
    The vacation check does not guarantee that a burglary or other crime will not occur at the residence, and it is only intended to be a request for the officer to check the home periodically, based upon the availability of the officer. Consequently, it is recommended that you make every effort to safeguard against losses including securing of high-value property, proper locking devices, alarm systems, etc. No vacation checks while the homeowner is gone from the home are guaranteed. No further police response or protection is being guaranteed by the vacation check other than the normal police service and protection, which is provided to the general public.
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