New Customer Registration Form

Home Vacation Check Form
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Format: (000) 000-0000.
E-mail
example@example.com
Date you leave for vacation

MonthDayYear
Date
Date you return from vacation

MonthDayYear
Date
Do you want LPD to check access from back yard? (Please leave any gates unlocked)
Will there be pets in the house or on the property?
Will there be any vehicles in the driveway?
Will there be any lights on automatic timers?
If yes, to automatic timers, which rooms are they in?
Please name anyone checking on your home

First NameLast Name
Contact number for anyone checking on your home
Please enter a valid phone number.Format: (000) 000-0000.
Please alert your neighbors that LPD will be checking on your property while you are away so they are not surprised when we are there. Community Safety Volunteers will periodically check homes and sometimes be there after dark with flashlights.
Should be Empty:

Home Vacation Check Form