West Dundee Police Department House Watch Request

Start Date*Required
End Date *Required
Address *Required
Name*Required
Request Made By
Phone*Required
E-Mail Address: *Required


Reason for Extra Patrol: Premise Will Be Vacant Other


Type Premise: Business Residence Other

Protected By Alarm System? Yes No

Lights On? Yes No


Keys Left with Anyone? Yes No

Other Persons Who Will Have Access To Premises (relatives, workers, neighbors, employee, etc.)
Person 1:
Person 2:

In Case of Emergency, Who Do You Wish Us To Call & How?
C/O Name Address Phone

Other Info You Care to Add: