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2. 
3. NOTICE:

   A dwelling must be unoccupied for no less than three (3) days and no more than thirty (30) days in a twelve (12) month period to qualify for the vacation watch program.  A vacation watch will not be accepted for a dwelling that has prior requests within a twelve (12) month period, or a dwelling that is occupied at any point during the vacation watch period.  Dwellings that are actively “for sale” are not eligible for the vacation watch program.  By submitting this form you have given the Palatine Police Department permission to enter upon your property for the purpose of checking your property for open doors, windows or damage.

5. First Name*
6. Last Name*
8. Email Address*
10. Date Leaving*
    Date Leaving
11. Date Returning (Not to exceed 30 days in 12 month period)*
    Date Returning (Not to exceed 30 days in 12 month period)
13. Phone Number*
14. Home Phone Number
16. Address
17. City(Must be Palatine)
19. State
20. Zip Code
24. Emergency Contact Person
26. First Name
27. Last Name
29. Emergency Contact Phone Number
31. Provide a list of any other keyholders and their phone numbers:
32. Provide a list of other person authorized to be on your premises:
34. Alarm System on Site?*

    1. Yes
    2. No
35. Interior Lights On?*

    1. Yes
    2. No
37. Exterior Lights On?*

    1. Yes
    2. No
38. Utilization of home care services (lawn care, cleaning, snow removal, etc.)?*

    1. Yes
    2. No
42. List any pets left on premises (include type of animal - dog, cat, etc.):
43. List the Make/Model/Color/Registration of all vehicles left on the premises:
45. Please include any additional relevant information:
Leave This Blank:


46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit

* indicates a required field