Vacation Watch Request

2. 
4. Today's Date *
   Today's Date
6. First Name*
7. Last Name*
9. Address
11. Address Line 2
13. City*
14. State*
15. Zip Code*
17. Home or Cell Phone *
18. Email Address*
20. Start Date(s) Dwelling Will Be Vacant*
    Start Date(s) Dwelling Will Be Vacant
21. Last Day Dwelling Will Be Vacant*
    Last Day Dwelling Will Be Vacant
23. Emergency Phone Number*

    Please provide a secondary number in case of emergency.

25. Name of Local Emergency Contact
27. Address of your emergency contact
29. Address Line 2
31. City
32. State
33. Zip Code
35. Emergency Contact Phone Number*
36. Emergency Contact Email Address*
38. Does your emergency contact have keys to the dwelling?

    1. Yes
    2. No
    3. I don't know
40. Please list any potential hazards the Police Department should know about:
42. Will there be any cars parked in the driveway, on the property or on the street in front of the house?

    1. Yes
    2. No
    3. Other
43. If Other, Please Specify
45. Do you expect any people coming/going from the house, i.e., contractors, family, house cleaners, pet sitters, etc.?*

    1. Yes
    2. No
47. Please give us the names of anyone who should not be at your home.
49. If you have an alarm system, please give us the name of the company and phone number:

51. I hereby agree to hold harmless the City of Mukilteo, the Mayor, Police Chief, all Police Officers and volunteers, and all employees of the City of Mukilteo for any and all claims 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 City of Mukilteo. Further, I understand and agree that this service does not create a special duty upon the City of Mukilteo and will be provided only as time is available, and no guarantee is made nor assurance given against loss, theft or damage to premises. *

53. Terms of Service

    1. I agree and understand the terms of this service.
    2. I do not agree to these terms and understand that my request for the vacation watch service will NOT be provided to me.
Leave This Blank:


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

    This field is not part of the form submission.

57. Submit

* indicates a required field