2. INFORMATION

   This watch will not be active until approved by the Police Department, and may take up to 2 days to be processed.  You will receive an email or phone call when your watch request has been processed.  

4. REQUESTOR
6. First Name*
7. Last Name*
9. Phone Number*
10. Email*
12. Type of Watch*

    1. Vacation Watch
    2. Security Watch
13. START Date*
    START Date

    START Date
14. END Date*
    END Date

    END Date
16. LOCATION
18. Type of Premise*

    1. Residence

    1. Business

    1. Other:
20. Business (If Applicable)
22. Address*
24. City*
25. State*
26. Zip*
28. EMERGENCY CONTACT
30. Emergency Contact #1
31. Emergency Contact #1
33. Emergency Contact #2
34. Emergency Contact #2
36. GENERAL
38. RELATED INCIDENT*

    1. Yes (Reported with Midlothian)
    2. Yes (At another Police Agency)
    3. No

    Is this watch being requested after a previously reported incident?

39. Incident #
40. Other Agency
42. KEYS TO PROPERTY*

    1. Yes
    2. No

    Have keys to the property been left with anyone?

43. Keyholder

    IF YES:

44. Number
46. AUTHORIZED PERSONS*

    1. Yes
    2. No

    Will anyone be working, or have authorized access to your premise during your absence?

47. List Authorized Persons

    IF YES:

49. VEHICLES*

    1. Yes
    2. No

    Will there be any vehicles left outside?

50. List Vehicles
52. IN CASE OF EMERGENCY*

    1. Myself
    2. Emergency Contact 1
    3. Emergency Contact 2

               Who should Police contact first in case of emergency? 

54. ADDITIONAL INFORMATION

    List any information you believe is relevant for the police department to know about this watch, or information officers checking your property should know.  

Leave This Blank:


56. 1. Receive an email copy of this form.
57. Email address

    This field is not part of the form submission.

58. Submit

* indicates a required field