Please fill in the House Check Form below.

House Check Form

Your Name:
Property Address: , Winter Springs, Fl
Color of House:
Phone Number:
Contact Email:
Date of Departure:
Date of Return:
Address Where Owner May Be Contacted:
Emergency Phone:
Collect Phone Call Authorized :
 Yes No
Will Keys Be Left With Caretaker?
 Yes No
If Yes, List name, phone and Address:
Is Yard Fenced:
 Yes No Locked? Yes No
Do You Have A Pool?
 Yes No
Any Animals on Premises?
 Yes No
If Yes, Please list types
Is Residence Alarmed?
 Yes No
If Yes, Please list types
Silent Audible Phone
Automatic Manual Resets
Will Any Lights Be On?
 Yes No
If Yes, describe room or area:
Will Any Vehicles Be At Residence?
 Yes No
If Yes, indicate tag numbers:
List Name(s) of any person(s) authorzied to enter residence and/or property during absence: (maid, pool man, etc.)

I hereby certify that I am the owner and/or authorized representative of the property listed hereon, and request that Selective Enforcement (house check) be made periodically at this location for the time period indicated above. During my absence, I hereby invite and authorize any member of the Winter Springs Police Department to enter my premise for the purpose of conducting security inspections to insure the timely protection of my residence and property, and to effect the arrest of any unauthorized person(s) thereon in connection with the protection requested. In this connection, I hereby agree to sign and file any required affidavits and/or complaints with the Police Department and/or State Attorney's Office to effect the prosecution of any malefactors.

I understand this authorization becomes effective upon the date of my departure, and will automatically cancel on the listed return date unless I call to extend the time period.

Type Your Name: