Vacation/Security Check Request Form

2. I request that a security check be made of my property and understand that Vacation Checks are done by Dublin Police Services as time and personnel are available.

   I request that a security check be made of my property and understand that Vacation Checks are done by Dublin Police Services as time and personnel are available.

4. Disclaimer
   Dublin Police Services and the City of Dublin do not assume any liability for your residence during specified dates. Vacation/Security Checks are not to be used as a substitute for security measures. Police Officers do not go into backyards. Checks are front yard perimeter checks only, and there is no guarantee that vacation checks will be done daily.

   Dublin Police Services and the City of Dublin do not assume any liability for your residence during specified dates. Vacation/Security Checks are not to be used as a substitute for security measures. Police Officers do not go into backyards. Checks are front yard perimeter checks only, and there is no guarantee that vacation checks will be done daily.

6. *Please submit your request at least five (5) days prior to your planned departure.

   *Please submit your request at least five (5) days prior to your planned departure.

8. First Name*

9. Last Name*

11. Address to be checked (Dublin addresses only):*

13. Apt # (if applicable)

15. Home Phone*

16. Cell Phone*

18. Email Address*

20. Date and Time Leaving*

21. Date and Time Returning*

23. Local Emergency Contact (Name)*

24. Phone*

26. Vehicles Left on Premises:
    Please describe all vehicles you plan to leave in the driveway or in front of the residence while on vacation. Please include the license plate number, make, and color. Note: According to Dublin Municipal Code 6.04.430, vehicles should not be parked on the street for more than 72 consecutive hours.

    Please describe all vehicles you plan to leave in the driveway or in front of the residence while on vacation. Please include the license plate number, make, and color. Note: According to Dublin Municipal Code 6.04.430, vehicles should not be parked on the street for more than 72 consecutive hours.

28. Vehicles:

30. Pets on Property:
    Please list all pets that will be staying on the property while you are away.

    Please list all pets that will be staying on the property while you are away.

32. Pets:

34. Name and phone number of person(s) caring for pets:

36. People with Permission to be on Property:
    Please list all persons you are expecting at your residence while you are away. This includes family/friends, pet sitters, gardeners, house/pool cleaning service staff, neighbors picking up mail, etc. List name, title, and vehicle license/make/color.

    Please list all persons you are expecting at your residence while you are away. This includes family/friends, pet sitters, gardeners, house/pool cleaning service staff, neighbors picking up mail, etc. List name, title, and vehicle license/make/color.

38. Permission 1:

40. Permission 2:

42. Additional Information:

Leave This Blank:


44. 1. Receive an email copy of this form.
45. Email address

    This field is not part of the form submission.

46. Submit

* indicates a required field