Forms • City of Madison • CivicEngage

VACATION CHECK REQUEST

Vacation checks are for two weeks. If you are gone longer, this request will become a “patrol frequently” and an officer will drive by your residence.

THE MADISON POLICE DEPARTMENT WILL NOT PROVIDE A VACATION CHECK.

IF SOMEONE IS CHECKING THE RESIDENCE, FEEDING PETS, WATERING PLANTS, ETC.

IF THE RESIDENCE IS AN APARTMENT OR HAS AN ALARM.

IF THE RESIDENCE IS FOR SALE AND HAS A LOCK BOX ON THE DOOR OR A REALTOR WILL BE SHOWING THE HOUSE.

Name*

Home Phone

Cell Phone*

Address*

Location of street number on the house?*

Email Address*

House have an alarm?*

No

Yes

Date leaving*

Time*

Date returning*

Time*

Vehicles at the home

Make / Model

Color

Year

Location of this vehicle

Make / Model

Color

Year

Location of this vehicle

Lights within the home

Lights left on in the house*

Yes

No

Lights on a Timer?

Yes

No

Light location(s)

Animals at the home

Animals at the house?

Yes

No

Animals(s) bite?

Yes

No

Back yard fenced

Yes

No

Gate locked? (Officer will not climb over a fence)

Yes

No

What kind of animals?

Name of person caring for your animals*

Home Phone

Cell Phone*

Address*

Local Emergency Contact

Name*

Home Phone

Cell Phone*

Address*

Will this person have a key to your home?

Yes

No

Will this contact have a person number for you?

Yes

No

Created by the Law Enforcement Technology Coordinator

* indicates required fields.

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