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Eastern Adams Regional
Police Department

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Vacation Check List Form

Complete the form below to send us your vacation information. A PDF version is also available by clicking here.

Complete the form below to notify us of your upcoming vacation.

Your Contact Information

Name:

Address:

Telephone:

Vacation Details

Destination Address & Phone (Hotel, Room#, etc.):

Departing Date:

Departing Time:

Returning Date:

Returning Time:

Location to be checked

Address to be checked:

Details on location (vehicles on premises, lights left on, pets, alarms, etc.):

Emergency Contact or Person Checking on Residence (name, address, phone, vehicle description):

Other Persons allowed on premises (name & address):

Any past history of suspicious activity? Yes No

Additional Information:

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Serving: Berwick Township, New Oxford Borough, & Oxford Township