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Security Check Form

  1. Reason for Patrol*
  2. Type of Premises:*
  3. Protected by alarm system:*
  4. Lights on:*
  5. Constant:*
  6. Automatic:*
  7. Keys left with anyone:*
  8. Please provide the following information of anyone with keys to your premises.
  9. In case of emergency, do you wish to be contacted?*
  10. Premises must be vacant for five or more days to be eligible for this program.
  11. I agree that I am allowing the Waukee Police Department permission to check my premises during the time period listed above.*
        1. Leave This Blank:

        2. This field is not part of the form submission.