Southern Regional Police Department
Vacation Check Request Form

This form can be used to notify the police department when residents will be out of town. The supplied information will remain strictly confidential and will only be used in case of an emergency.

The police department will attempt to check the exterior portion of the properties as time permits but property owners should arrange to have family or friends check the properties, remove mail from mailboxes, and remove newspapers. Any questions should be directed to the police department at (717) 235-3944.


* = required
Date Leaving *   MM/DD/20YY
Date Returning *   MM/DD/20YY
Name *
Address *
Home Phone *
Cell Phone
Emergency Contact *
Emergency Phone *
Home Alarm System
     Name/Number
Please share any additional information:

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