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2. 
3. City of Edgewood

   2224 104th Avenue East, Edgewood, WA 98372-1513

   City Hall Phone: 253-952-3299 | Police Department Phone: 253-798-4960

7. Residence Vacation Check Request

   If you are an Edgewood resident, are planning to be away from home for at least 5 days but not more than 90 days, and would like the Edgewood Police to perform residence checks on your home and property in your absence, please complete this form at least 7 days before your scheduled departure. We are not able to accept requests made by telephone.

   The information contained in this form will be used to perform an inspection of your property as City of Edgewood Police Department time and resources permit. There is no guarantee any check(s) will be performed or that loss, theft, or damage to property or persons will be prevented by submitting this form. If suspicious activity or other incident is observed at the property, you and/or the person listed as the emergency contact below will be notified. Please do not submit this form if you will have a house-sitter or other guest(s) staying at the property at any time and for any duration during your absence. Edgewood Police Department, as used throughout this form, shall mean any Pierce County Sheriff’s Department Deputy carrying out duties or activities on behalf of the City of Edgewood. 

   
   

9. First Name
10. Last Name
12. Phone Number
14. Address
16. City
17. State
18. Zip Code
20. Email Address
22. Dates Gone
24. Alarm Company
25. Phone #
27. Names & Phone Number of Anyone Coming to Residence
    Anyone getting mail, watering/feeding animals, etc.
29. Vehicles at Residence
    Include any that will be at residence for any reason.
31. Make
32. Model
33. Lic #
35. Make
36. Model
37. Lic #
39. Make
40. Model
41. Lic #
43. Animals at Residence - Farm or Domestic
45. Anything Unusual Police Deputies Should Be Aware of
47. Emergency Contact
49. Name
50. Phone

52. By submitting this form, I acknowledge this is a free and voluntary service provided by the Edgewood Police Department as time and resources permit, and therefore does not guarantee any particular frequency of vacation checks or that any checks will be performed, nor does it guarantee such checks will prevent any loss, theft or damage to property or any person. I further acknowledge this service does not create a special duty upon the City of Edgewood or the Edgewood Police Department. I expressly authorize the Edgewood Police Department to enter upon the property listed to perform an inspection, and I agree to defend and hold harmless the City of Edgewood, its representatives, agents, employees, officials, contractors, and volunteers, from any and all liability, claims, suits, damages, injuries (including death), expenses, fees (including reasonable attorneys’ fees), actions or rights of actions or judgments which in any way relates to or arises out of any action or lack thereof by the City of Edgewood in carrying out this service.

    I acknowledge the City of Edgewood is a public agency subject to the Washington State Public Records Act (PRA), Chapter 42.56 RCW. This document is a public record, and I acknowledge this document and any of the personal information contained herein may be disclosed in response to a public records request, in accordance with the PRA. 

54. Signature
55. Date
    Date
Leave This Blank:


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

    This field is not part of the form submission.

59. Submit

* indicates a required field