Type of Dwelling
Name
Address
Name
Phone
Address
Name
Phone
Address
yes
no
yes
no
Type
Alarm Company
Phone
yes
no
Where
yes
no
yes
no
Type/Location
Person responsible for their care?
Day Phone
Evening Phone
yes
no
yes
no
yes
no
yes
no
yes
no
If yes, Name:
phone
yes
no
When are your sprinklers timed to turn on and off?
Make
Model
Color
Year
State
Lic. #
Make
Model
Color
Year
Lic. #
State
Other property
I understand and agree to the above terms and conditions.
Date leaving
Date returning
Persons that can respond in an emergency
The following person (s) are authorized to enter the property, or in case of emergency contact:
Vacation House Check Request
Does the above named party (s) have a key to the property?
Does the premise have an alarm?
Lights left on?
Timer?
Are there any animals on the premises?
Persons that have access to the premises/additional data
(i.e. gardener, cleaning person, neighbor, etc.)
Property Information:
Do you have any broken doors or windows?

Do you have any torn screens?

Do you have timers on any indoor/outdoor lights?

Will you stop your mail and newspaper delivery?
If not, will someone be collecting them for you?
Do you want your backyard checked?
Locked gates will not be opened.
Describe vehicles or property left outdoors while on vacation:
Note: Be sure to make arrangements for your mail/newspaper and for lawn care/snow removal.
The undersigned authorizes the Amity Township Police Department to have officers enter my property and visually inspect the house exterior. Should an open entry be found the undersigned authorizes the police to enter my house for further inspection. The police will attempt to secure the house and contact the owner or person caring for the house that is listed above. The undersigned understands and agrees that this is a voluntary, free service and does not create a special duty upon the Township, and will be provided depending upon weather and available time. No guarantee is made no assurance given against loss, theft or damage to the premises. The undersigned agrees to hold harmless the Township of Amity, its employees and agents for any and all claims for personal injury, loss or damage to property that may be suffered through any action or lack thereof by a representative of the Township of Amity.
Please call the police department at 610-689-6002 when you return.
Amity Township Police Department
2004 Weavertown Rd. Douglassville, PA 19518
610-689-6002