Vacation Check Request Form (21 day maximum)

Questions about whether the information you submit is private: please read the City of Beaverton Web Site Privacy Policy.
Further questions about the City’s privacy policy: send an email to citymail@BeavertonOregon.gov.

If you live within the City of Beaverton, and would like to have vacation checks performed on your residence, please complete this form and submit it to the Beaverton Police Department.

The form must be turned in to the Police Department at least 72 hours prior to the desired start of the vacation check. The duration of the vacation checks will be no more than 3 weeks but not less than 1 week. Vacation checks will be performed as time allows. You must notify the department immediately if departure or return times change.

You must notify the department immediately if departure or return times change.

About You (required)

(format: 999-999-9999)


Date and time when you want your house monitored (required)

PrevJuly 2017Next
SunMonTueWedThuFriSat
2526272829301
2345678
9101112131415
16171819202122
23242526272829
303112345

PrevJuly 2017Next
SunMonTueWedThuFriSat
2526272829301
2345678
9101112131415
16171819202122
23242526272829
303112345

(required)

Vehicles Describe vehicles or property left outdoors while on vacation:
  License PlateMakeModelYearColor
Vehicle 1
Vehicle 2
Vehicle 3


Alarms
Do you have an alarm system? (required)
Is your alarm system monitored?


(format: 999-999-9999)

(if you have a permit)

Do you have any broken doors or windows? (required)
Do you have any torn screens? (required)
Lights
Are there any indoor/outdoor lights to be left on? (required)


Do you have timers on any indoor/outdoor lights? (required)


Mail (required)
Will you stop your mail and newspaper delivery?
If not, is someone collecting them for you?

(Please note this is not a service the Beaverton Police Department will provide, but is highly recommended.)

Pets (required)
Are there any pets in the house or yard?


Emergency Contact

The following person(s) are authorized to enter the property:

(format: 999-999-9999)


Does the above named party have a key to the property?

(For example, add more emergency contacts.)

The undersigned does hereby grant and request that the Beaverton Police Department visually check the property listed above, which may include access to the yard. The undersigned does hereby agree to hold harmless the City of Beaverton, its employees and agents for any claim for personal injury, loss or damage to property that may be suffered by the undersigned, through any action or lack thereof, by a representative of the City of Beaverton. Further, the undersigned understands and agrees that this is a voluntary, free service and does not create a special duty upon the City and will be provided only as time and personnel are available and no guarantee is made nor assurance given against loss, theft or damage to premises.

(required)

(required)


Questions about this Web application: webmanager@BeavertonOregon.gov

Courage, Compassion, Integrity