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Vacation / Security Check Request Form

Updated March 24, 2014

JUMP TO: Request Form

The Cerritos Sheriff's Station/Community Safety Center offers free vacation security checks for residents. While you're away, a Volunteer on Patrol will check your home for broken windows, open doors or other suspicious clues.

Please submit this form at least 5 working days in advance of leaving on vacation. All information on the form must be completed in order for your request to be processed. If it is less than 5 working days from when you will leave, please call (562) 916-1266 to submit a vacation security check request by phone.

Be sure to lock all doors and windows. Please notify the Community Safety Division at (562) 916-1266 if you return before your indicated return date.

Request Form

TYPE OF REQUEST

* Required: select a type of security check request below.

* Required: Enter in the type of other security check
or select a different type of security check request below.

Vacation invalid entry ok
Fumigation
Other: invalid entry ok

Security Check Dates and Times

* Required: Please write your leave date below in the format MM-DD-YYYY.
For example, December 22, 2014 is 12-22-2014.

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(mm-dd-yyyy)
 

* Required: Please anter an approximate start time below.

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* Required: Please write your return date below in the format MM-DD-YYYY.
For example, December 22, 2014 is 12-22-2014.

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(mm-dd-yyyy)
 

* Required: Please enter an approximate end time below.

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Your Contact Info

* Required: Please enter your name below.

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* Required: Please enter your address below.

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Cerritos, CA 90703

* Required: Please enter your work phone number below.

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* Required: Please enter your cell phone number below.

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* Required: Please enter your e-mail below.

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Emergency Contact Person and Visitors

* Required: Please enter your emergency contact's name below.

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* Required: Please enter your emergency contact's home phone number below.

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* Required: Please enter your emergency contact's work phone number below.

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* Required: Please enter your emergency contact's cell phone number below.

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* Required: Please fill in "Yes" or "No" to the question below.

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No

* Required: Please fill in "Yes" or "No" to the question below.

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No


* Required: Please provide the vitior's name, relationship, and date/day/time the visitor will be at your property.



Alarm Company

* Required: Please fill in "Yes" or "No" to the question below.

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No

* Required: Please enter your alarm company's name below.

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* Required: Please enter your alarm company's phone number below.

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Lights and Surroundings

* Required: Please fill in "Yes" or "No" to the question below.

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No

* Required: Please fill in "Yes" or "No" to the question below.

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No

* Required: Please fill in "Yes" or "No" to the question below.

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No


Vehicles

* Required: Please select the number of vehicles below.

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Vehicle Number 1

* Required: Please enter the vehicle make below.

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* Required: Please enter the vehicle model below.

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* Required: Please enter the vehicle year below.

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* Required: Please enter the vehicle color below.

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* Required: Please enter the vehicle license plate number below.

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Vehicle Number 2

* Required: Please enter the vehicle make below.

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* Required: Please enter the vehicle model below.

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* Required: Please enter the vehicle year below.

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* Required: Please enter the vehicle color below.

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* Required: Please enter the vehicle license plate number below.

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Vehicle Number 3

* Required: Please enter the vehicle make below.

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* Required: Please enter the vehicle model below.

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* Required: Please enter the vehicle year below.

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* Required: Please enter the vehicle color below.

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* Required: Please enter the vehicle license plate number below.

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Pets, Deliveries, and other Services

* Required: Please fill in "Yes" or "No" to the question below.

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No

* Required: Please fill in "Yes" or "No" to the question below.

Yes invalid entry ok
No

* Required: Please fill in "Yes" or "No" to the question below.

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No

* Required: Please fill in "Yes" or "No" to the question below.

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No

* Required: Please enter a day for lawn service.

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* Required: Please fill in "Yes" or "No" to the question below.

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No

* Required: Please enter a day for pool service.


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DETAILS

Please type any other information you want us to know. (Please limit your message to 1,000 characters or less.)

* Required: Please shorten the message below to 1000 characters or less.


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