Police - Neighborhood Watch Captain Information
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Position
Captain
Co-Captain
Email
example@example.com
Secondary Email
example@example.com
Home Phone Number
-
Area Code
Phone Number
Best Time to Call:
Work Phone:
-
Area Code
Phone Number
Best Time to Call:
Cell Phone:
-
Area Code
Phone Number
Best Time to Call:
Pager:
Fax:
-
Area Code
Fax Number
The Glendale Police has my permission to release my name, address and phone number to any of the following checked persons or entities:
Residents in my Neighborhood Watch Area
Other Neighborhood Watch Captains
City of Glendale Departments (Mayor, City Council, Fire, etc.)
Association Name
Number of homes in your neighborhood watch area:
Number of homes participating in the watch area:
Your neighborhood watch area has metal neighborhood watch signs:
Yes
No
If yes, please give sign locations:
Your neighborhood is a registered neighborhood with Neighborhood Services:
Yes
No
If your neighborhood watch group has had activities or events in the past, please provide dates:
Please provide your initials as a form of electronic signature:
Date
-
Month
-
Day
Year
Date
Please provide the name of your watch group's co-captain or captain for the purposes of matching records:
Co-captain or captain's e-mail address:
example@example.com
Submit
Should be Empty: