Community Watch Form - CITY OF WILLARD, OH

419.933.2581

CITY OF WILLARD, OH

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Community Watch Form (House & Business Check)

Please enter all information below for the Community Watch.

Name & Address of Watch Location

Date/Time & Watch Type

* Indicates required field

Name *

First

Last

Please enter the First and Last name of the person living at the Community Watch Location.

Address *

Line 1

Line 2

City

State

Zip Code

Country

Please enter your address information including any apartment number, lot number, suite number, etc.

Phone Number *

Email *

Start Date *

Please enter the Start Date that you would like a Police Officer to begin the Community Watch.

Start Time *

Please enter the Start Time that you would like a Police Officer to begin the Community Watch.

End Date *

Please enter the End Date that you would like a Police Officer to stop the Community Watch.

End Time *

Please enter the End Time that you would like a Police Officer to stop the Community Watch.

Please Select Type of Watch *

Please select the type of watch being requested.

Contact Information (Person who should be contacted while you are away)

Primary Contact Name *

Please enter the Primary Contact Information of who we should contact while you are away. This person might be someone who is watching your residence while you are away.

Phone Number (Pri) *

Is the Primary Contact a keyholder? *

Yes No

Secondary Contact Name *

Please enter the Secondary Contact Information of who we should contact while you are away. This person might be someone who is watching your residence while you are away.

Phone Number (Sec) *

Is the Secondary Contact a keyholder? *

Yes No

Property Information (Select all that apply)

Authorized Vehicles On Site

Lighting Information *

Front Back Side First Floor Second Floor Basement Bathrooms Bedrooms Kitchen Living Room Lights on Timers No Lights Will Be Left On

Special Information *

Alarm System Mail Stopped Newspaper Stopped Pets on site None

Color of Vehicle #1 *

Color of Vehicle #2 *

Make of Vehicle #1 *

Make of Vehicle #2 *

Model of Vehicle #1 *

Model of Vehicle #2 *

License Plate State of Vehicle #1 *

License Plate State of Vehicle #2 *

License Plate Number of Vehicle #1 *

License Plate Number of Vehicle #2 *

Provide Additional Information Here *

Submit Watch Form

City of Willard, Ohio - www.WillardOhio.us - 419.933.2581

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