House Check Request

Going out of town soon? Fill out the House Check Request Form below to request an officer to stop by and check on your home while you're away. Contact Information Your Name PIN Number Create your own personalized 4-digit PIN Home Address House Color Phone Number E-mail Address Confirm E-mail Address Time of Leave Departure Date Departure Time Return Date Return Time Caretaker Information Will there be a caretaker? Will there be a caretaker? Yes No Caretaker Name Caretaker Phone Caretaker Address Keyholder Information Will there be a keyholder? Will there be a keyholder? Yes No Keyholder Name Keyholder Phone Keyholder Address Other Information Is Yard Fenced? Is Yard Fenced? Yes No If Yes, is Fence Locked? Is Fence Locked? Yes No Swimming Pool? Swimming Pool? Yes No Animals on Premises? Animals on Premises? Yes No If Yes, List Types of Animals Does Home have an Alarm System? Does Home have an Alarm System? Yes No Alarm Type? Alarm Type? Silent Audible Phone Automatic Manual Resets Any Lights to be left on? Any Lights to be left on? Yes No Locations where Lights are to be left on. Any Vehicles Remaining on Premises? Any Vehicles Remaining on Premises? Yes No List Vehicles Tag Numbers List Any Persons Allowed on Premises or Inside Home (Lawn Care, Maid, Pest Control) Authorization Enter Name Here to Authorize Form Authorization Check Signature Authorization Check Signature I hereby certify that I am the owner and/or authorized representative of the property listed hereon, and request that Selective Enforcement (house check) be made periodically at this location for the time period indicated above. During my absence, I hereby invite and authorize any member of the Winter Springs Police Department to enter my premise for the purpose of conducting security inspections to insure the timely protection of my residence and property, and to effect the arrest of any unauthorized perso I understand this authorization becomes effective upon the date of my departure, and will automatically cancel on the listed return date unless I call to extend the time period. I also understand that I will need the correct PIN provided on this form when I call. View PDF of Page