neighbors helping neighbors

Vacation Check Request

Vacation Check Request

This form should be used by Winfield residents requesting Winfield Police Department to provide the service of visually checking your residence while you are out of town. Vacation checks are offered as a courtesy. Because Police activity levels vary greatly this service is provided as time and personnel are available and does not create a special duty upon WPD. It is understood there is no guarantee that this service will be provided on a daily basis. If you concure with these terms, complete the following form and click "SUBMIT". By doing so it will be forwarded to the Winfield Police Department. If for some reason you return early or need the directed patrol removed please contact Police Department, 620-221-5556.

Contact Information

Name:


Location to patrol (address, Apt #, etc.):


City:


State:


Zip:


Home Phone Number:


Cell Phone Number:


Email Address:


Schedule Information

Start Date (mm/dd/yy):


End Date (mm/dd/yy):


Security Alarm System

Do you have a security alarm system installed?                           Yes      No

If yes, is your alarm system monitored by a monitoring service?           Yes       No

If yes, what is the name of the monitoring company?                                   

Lighting Information

Will there be lights on at the location?                                 Yes       No

If yes, location of lights to be on (ex: porch, left window, driveway, etc.):  

Will any outside lights be actived by motion detectors?                              Yes        No

Vehicles

Will there by any vehicle(s) left at the location in sight?                              Yes         No

If yes, complete the following vehicle information:
Vehicle #1 Description (make, model, color, license, location):              

Vehicle #2 Description (make, model, color, license, location):              

Access

Will anyone have access (key) to the location while you are away?         Yes           No

Name:                                                                                                                                     

Phone Number:                                                                                                                 

Will anyone be at the location while you are away (cleaning person, checking mail, feeding animals)?                 Yes          No

Name:                                                                                                                                     

Phone Number:                                                                                                                 

Miscellaneous Information                                                                                        

Hold Harmless
Winfield Police Department, as per your request, will periodically check your location listed above. By clicking the "SUBMIT" button it is understood and agreed that neither the Winfield Police Department or City of Winfield assumes any liability with the Vacation Check Program.