The Hillside Police Department will conduct security checks to all residents who will be away from home and have no one staying or checking on the home while away. Name: * Address: * Phone Number: * Lights Left On? Yes No Light Timer: If a light timer is used, please enter the set times. Windows Locked? Yes No Drapes Closed? Yes No Mail Stopped? Yes No Newspaper Stopped? Yes No Neighbors Informed? Yes No Key Holder: Animals on Premises? Yes No Types of Animals: Number of Authorized Cars on Premises (0-10): Describe Each Car: Include Make, Model, Year, Color, License No. for each car. List of Authorized People on Premises: Emergency Contact: Does Your Emergency Contact Have a Key to House? Yes No Emergency Contact Address: Emergency Contact Phone Number: Comments/Additional Information: I understand that the Hillside Police Department and the Village of Hillside do not have any liability from any loss or damage during the specified period and I waive and release them from any liability. eSignature: * Date: * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20222023202420252026 Leave this field blank