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Resident Vacation Check Request

  1. Resident Vacation Check Request
    Springdale Police Department
    118 Lion Boulevard
    Springdale, Utah 84767

    Phone: 435-772-9096
    Fax: 435-772-0702
  2. Resident Information
  3. Local Emergency Contact
  4. Vehicle Information
  5. Authorized Access
  6. Alarm Information
  7. Set Timer Information
  8. Other Information
  9. The undersigned does hereby grant and request that the Springdale Police Department visually check the property listed above, which may include access to the yard. The undersigned does hereby agree to hold harmless the Town of Springdale, its employees and agents for any claim for personal injury, loss or damage to property that may be suffered by the undersigned, through any action or lack thereof, by a representative of the Springdale Police Department. Further, the undersigned understands and agrees that this is a voluntary, free service and does not create a special duty upon the Town and will be provided only as time and personnel are available and no guarantee is made nor assurance given against loss, theft or damage to premises.
  10. I understand checking this box and typing my name below constitutes my signature*
  11. All information on this request form will be kept confidential and will only be used by the Springdale Police Department
  12. Office Use Only
  13. Leave This Blank: