Residence Security Check Request Form

Owner's Name(Required)

First Last

Phone

Your Address(Required)

Street Address Address Line 2 City State ZIP Code

Your Email Address

Email Address Confirm Email Address

Type of Resident(Required)

House
Apartment
Business

Date of Leaving(Required)

Date of Return(Required)

General Information

Lights:

Select All
Lights On
Set on Timer

Keys:

Left with Responsible Person

Name of Responsible Person

First Last

Phone

Persons permitted on property:

Click the button on the right to add more individuals who are authorized to be on the property.

First	Name

Vehicles left at the property:

Click the button on the right to add more vehicles.

License #	Year	Make	Model	Color

Any animals left at the property?

Yes
No

If yes, please explain/describe:

Additional Information

I/We request that the Ruston Police Department check the property listed above during the dates specified while we are away. I/We authorize the Police Department and their authorized representatives to enter our property to inspect its security and take any necessary actions to protect it. I/We agree to hold the City of Ruston, the Ruston Police Department, and any of its authorized representatives harmless from any damages or loss of property that may occur while they are performing their official duties to safeguard our property. The Vacation House Check/Inspection Program is a service offered by the Ruston Police Department on a periodic basis, subject to availability and the demands of other calls for service. As such, there is no guarantee—either expressed or implied—that damage will not occur to your property or that you will not experience a loss while you are away. The Ruston Police Department, its employees, agents, and representatives are not liable for any damages to the property during the Vacation House Check/Inspection Program. By clicking submit, you acknowledge that you have read, understand, and agree to the above terms.

Consent(Required)

I have read, understand, and agree to the above terms.