North Caldwell Police Department
Confidential Registration
Resident
/
Alarm Information Sheet
It is mandatory under Borough Ordinance #22-5 that all alarm systems be registered with the police department. All information provided is kept confidential.
If additional space is required while completing the application please utilize the section located at the bottom of the form marked " additional information".
Resident Name:
*
Home Phone
*
Address:
*
Type of Alarm System:
Type of Notification:
Check All Which Apply:
Burglar Alarm
Fire Alarm
Panic Alarm
Check All Which Apply
Central Station
Local Annunciator (Bell or Siren)
Automatic Dialer To Police
Police Alarm Board
If you subscribe to an alarm service, please provide the name and phone for contact.
Alarm Company
Phone
Do you have a North Caldwell Police alarm code. If so, please list below. If not, the police department will provide an alarm code after all paperwork has been reviewed and processed.
Alarm Code:
Type of Reset for Alarm System:
Key
Code
Location of Alarm panel for emergency resets:
Provide any other helpful information or contacts below:
If one of the following sections does not apply to you, or if you are not comfortable providing such information, please leave the section blank or use N/A for not applicable.
Name:
E-mail Address:
Street Address:
Cross Street
Date Moved In:
Home Phone
If the home phone is not the primary number to receive reverse 9-1-1 emergency messages?Please list the primary number you wish to use.
List all residents normally living at this address,even if part time. ( If different last name please include in name section)
Name
Sex
Date of Birth
-
Month
-
Day
Year
Date
Relationship
Please Select
Wife
Son
Daughter
Mother
Father
Relative
Other
Other Explain
Name
Sex
Date of Birth
-
Month
-
Day
Year
Date
Relationship
Please Select
Wife
Son
Daughter
Mother
Father
Relative
Other
Other Explain
Name
Sex
Date of Birth
-
Month
-
Day
Year
Date
Relationship
Please Select
Wife
Son
Daughter
Mother
Father
Relative
Other
Other Explain
Name
Sex
Date of Birth
-
Month
-
Day
Year
Date
Relationship
Please Select
Wife
Son
Daughter
Mother
Father
Relative
Other
Other Explain
Name
Sex
Date of Birth
-
Month
-
Day
Year
Date
Relationship
Please Select
Wife
Son
Daughter
Mother
Father
Relative
Other
Other Explain
Name
Sex
Date of Birth
-
Month
-
Day
Year
Date
Relationship
Please Select
Wife
Son
Daughter
Mother
Father
Relative
Other
Other Explain
Are any of the above individuals handicapped
List name(s) and describe any special needs:
Your emergency contact information. ( Where can you be reached)
Name
Cell Phone
Business / Other
Name
Cell Phone
Business / Other
Emergency contacts if we cannot reach you:
1) Name
Home Phone
Address
City / State
Work / Cell Phone
Relationship
Do they Have Keys
Yes
No
2) Name
Home Phone
Address
City / State
Work / Cell Phone
Relationship
Do they Have Keys
Yes
No
Family Physician
Phone
Pediatrician
Phone
Owner of Property if Not You:
Phone
Address:
Vehicles garaged or normally kept at residence:
State / Plate #
Registered to:
Year
Color
Make / Model
State / Plate #
Registered to:
Year
Color
Make / Model
State / Plate #
Registered to:
Year
Color
Make / Model
State / Plate #
Registered to:
Year
Color
Make / Model
Do you have a key Box?
Yes
No
Do you own any firearms?
Yes
No
Firearms ID#
Do you have any pets
Yes
No
If yes, list name type of animal and breed / color for each
Pet Name
Type of Pet
Breed / Color
Pet Name
Type of Pet
Breed / Color
Pet Name
Type of Pet
Breed / Color
Pet Name
Type of Pet
Breed / Color
Additional Information:
Name of Person Completing Form:
*
*
By checking this box I certify the above information is true and correct to the best of my knowledge.
Submit
Should be Empty: