Vacation Home Check

Name*

First NameMiddle NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Best Contact Phone Number*

Secondary Contact Phone Number

Date Departing*

Date

Date Returning*

Date

Is there a house key on premises we can use to gain entry in case of emergency?*

YESNO

If YES, Where is key located?

Is there anyone we can call who has a key to your home in case of emergency?*

YESNO

If YES enter contact Name

First NameMiddle NameLast Name

If YES enter Phone Number

Will any Vehicles be on the property?*

YESNO

If YES, What type? / color of vehicle

Will home be vacant?*

YESNO

If NO, list name of occupant.

Will any lights be left on?*

YESNO

If NO, list name of occupant.

Does home have alarm system?*

YESNO

If yes, Alarm Company Phone Number

Any Remarks or Comments

Waiver Clause

“WAIVER” RELEASE AND HOLD HARMLESS THE CHARLTON COUNTY SHERIFF’S OFFICE  AND CHARLTON COUNTY 911  CENTER AGAINST ANY CLAIM IN RELATION TO SERVICE RECEIVED THROUGH THE VACATION HOME WATCH PROGRAM.
Subscriber acknowledges that the Charlton County Sheriff’s Office and Charlton County 911 Center are providing this service as a service and for no compensation. Subscriber recognizes that the Charlton County Sheriff’s Office and Charlton County 911 Center may, in their sole discretion, terminate this service at any time. In consideration of these factors, subscriber hereby waives, releases and hold harmless the Charlton County Sheriff’s Office and Charlton County 911 Center from any claim arising from a failure, for any reason, to provide the services contemplated by this agreement, and subscriber further agrees to waive, release and hold harmless the Charlton County Sheriff’s Office and Charlton County 911 Center against any claim for direct, incidental, or consequential damages arising from any action or omission of the Charlton County Sheriff’s Office and Charlton County 911 Center, their volunteers and/or employees, in connections with the Charlton County Sheriff’s Office and Charlton County 911 Center participating in this program.

By submitting this form the subscriber acknowledges and agrees to this Hold Harmless Waiver clause.

If your plans change and the home will not be vacant during the specified period of time notify Charlton County 911 at the non-emergency number (912) 496-7321.

Thank You for allowing us to serve you!