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2. First Name*
3. Last Name*
5. Address 1*
6. Address 2
8. City
9. State
10. Zip
12. Home Phone
13. Phone Number While You are Away*
15. Email Address
17. Emergency Contact
19. Emergency Contact Phone Number
20. Does this person have a key to your residence?

    1. Yes
    2. No
22. While You are Away
24. Will visible lights be left on (timer included)?

    1. Yes
    2. No
25. If you chose yes, what time will the timer be activated?
27. What visible lights will be affected?
29. What vehicles will be left at the residence or will be visiting the home? (Make, color, year, etc.)
31. Will there be dogs in the yard?

    1. Yes
    2. No
32. If you chose yes, where will they be located?
34. What is the reason we will be monitoring your home?
36. What day will you be leaving? (MM/DD/YY)
37. What day will you arrive home? (MM/DD/YY)
39. The Owasso Police Department will only monitor your home for a maximum of 2 weeks.
41. Would you like to be contacted regarding this information?

    1. Yes
    2. No
42. If you chose yes, how do you wish to be contacted?

    1. By Phone
    2. By Email
Leave This Blank:


44. 1. Receive an email copy of this form.
45. Email address

    This field is not part of the form submission.

46. Submit

* indicates a required field