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Police Home | Current Crime Information | Department & Community Events | Vacation House Check Form | Links

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Vacation House Check Form

The Bellbrook Police Department provides a free residential security check for residents of the City of Bellbrook who go on vacation or are away from home for an extended period of time. Residents utilizing the “Vacation House Check Program” can rely on a Bellbrook Police Department Officer to visit their residence and conduct a check of the home to make sure it is secure. Once per shift, as available, an Officer will inspect the residence for unlocked or damaged windows or doors, any evidence of forced entry or other suspicious activity, verification of vehicles left on the property, verification of any people found on the property, and any obvious mechanical malfunctions. Please be sure to have your house number displayed on your mailbox, or otherwise visible from the roadway.

This form is designed to provide the Bellbrook Police Department with information if you will be away from you home for any length of time. Information on this form is for the use of the Bellbrook Police Department ONLY, and will be kept secure and confidential.

Whenever possible, please provide this information 3 days PRIOR to your scheduled departure, and as always, have a safe and happy trip.

To confirm that your house check has been scheduled, please call us at (937) 848-8484.

Please provide the following contact information:

Name

Street Address

Cell Phone

Pager

Email

Leave Date:

-- mm/dd/yy

Leave Time:

Return Date:

-- mm/dd/yy

Return Time:

Lights on in the home during leave (check all that apply):

First Floor Lights
Second Floor Lights
Back Lights
Front Lights
Living Room Lights
Bedroom Lights
Kitchen Lights
Lights on a Timer (See Below)
Other (See Below)

If you answered "Lights on a Timer" above, please provide time period and location of lights:

If you answered "Other" above, please provide more information:

Have you put a stop/hold on your newspaper?

Yes No

Have you put a stop/hold on your mail?

Yes No

Authorized Vehicle on Site (Include Vehicles in Garage):

Make

Model

Color

Second Authorized Vehicle on Site (If Applicable):

Make

Model

Color

Third Authorized Vehicle on Site (If Applicable):

Make

Model

Color

Are there animals present?

Yes No

Are any of the animals vicious?

Yes No

Please provide the following key holder contact information:

Name

Street Address

City

State

Zip Code

Home Phone

Cell Phone

Pager

Please provide the following emergency contact information:

Name

Street Address

City

State

Zip Code

Home Phone

Cell Phone

Pager

Please provide the following emergency contact information (If Applicable):

Name

Street Address

City

State

Zip Code

Home Phone

Cell Phone

Pager

Do you have an alarm system?

Yes No

Does the alarm system have an automatic reset?

Yes No

Please provide the name of your alarm system company:

What type of alarm system do you have in your home?

Intrusion
Fire
Medical
Panic

Please provide the location of the alarm panel:

Please provide the following contact information for authorized person(s) on site:

Name

Street Address

City

State

Zip Code

Home Phone

Cell Phone

Pager

Please provide the following contact information for authorized person(s) on site (If Applicable):

Name

Street Address

City

State

Zip Code

Home Phone

Cell Phone

Pager

Please provide the following contact information for authorized person(s) on site (If Applicable):

Name

Street Address

City

State

Zip Code

Home Phone

Cell Phone

Pager

Additional Information (Optional):

Updated 10/29/09