APD Vacation Check Form (Form #367)

APD Vacation Check Form
In order to take part in this program you must live in the City of Albany.

Please complete this form in its entirety and click submit to email your information to the Albany Police Department.

Burglary Prevention Tips
Stop your mail and newspaper delivery.
Make arrangements for your walkway and driveway to be shoveled and plowed.
Make sure you have locked all windows and doors.
Leave a light on or set a timer for your lights.
Date*

MonthDayYear
Date
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date Leaving*

MonthDayYear
Date
Date Returning*

MonthDayYear
Date
Phone Number - best number to reach including while you are out of town*
Please enter a valid phone number.
Emergency Contact Information
Name*

First NameLast Name
Relationship*
Phone Number*
Please enter a valid phone number.
If you answer yes to any of the questions below, please give details.
Will your emergency contact have access to your residence?*

YesNo
If yes,
Will you be having anyone take care of your pets or checking in on your residence?*

YesNo
If yes,
Any additional information you would like to provide
Which police station do you report to?*

CenterSouth
Should be Empty: