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This will be used to verify your identity in the event you need to change information or authorize police actions on your behalf.
List the individuals you have selected as emergency contacts while you are away. These people
should 1. Know your plans 2. Be able to respond to your home with a key. 3. Know how to reset
your alarm. 4. Know when something is suspicious that needs attention. We will contact the
individuals you have designated in the order you have listed them, starting with the 1st Contact.
Please list the names and type of relationship for all other people expected to stop by the home.
These are known individuals who are not considered as a primary contact. (example; lawn care
provider, maintenance worker, pet sitter, designated person to pick up mail or newspaper)
Please describe the pets that may be left in the home. Include the type of animal (cat, dog), the
pets name, breed, color, collar or chip information, disposition of the animal (aggressive?)
Please describe any vehicles that are left behind while you are away, or any vehicles used by
individuals who may stop by your residence for other reasons. That may include relatives,
house-sitters, cleaning service, yards care service, pool-care company, and so on.
The text box below allows you the opportunity to provide additional information not covered
so far. This can include information that describes what lights may be on timers inside the
home, how mail or newspapers are being collected and by whom, previous damage to a
particular window or door, or any other information that you feel is important for us to know.
I hereby request members of the Lafayette Police Department to perform random House
Security Checks on my residence during my absence. The information contained herein is
accurate to the best of my ability. I agree to notify the Lafayette Police Department
immediately upon my return. I give permission for Lafayette Police Officers to enter my
property to conduct a security check of my property, and to enter the residence if exigent
circumstances are present. (Example: found open door or window, evidence of a burglary,
investigation of an alarm etc) I understand that the Lafayette Police Department will make
every effort to keep my residence secure, and I agree that there is no crime prevention strategy
that is absolutely effective against all crime. This Security Check is part of a layered approach to
crime prevention and I agree other steps should be taken on my behalf. I hereby hold harmless,
the Lafayette Police Department, of any circumstance beyond their control, which may result in
damage to my property.
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