Welcome to Elon, North Carolina

Home Vacation Request Form

This report is for members of the community to inform the Elon Police Department of an upcoming vacation.

Name:

Full Address:

Phone:

Email:

Date Leaving:

Time:

Date Returning:

Time:

Trip Destination:

Are you leaving a set of keys with anyone?

Yes No

If yes, whom?

Please list persons who should have access to the premises.

Person #1

Person #2

Person #3

Person #4

Person #5

Who should be contacted in the case of an emergency?

Name:

Will the lights be turned on?

Yes No

Are the lights on a timer?

Yes No

Will vehicle(s) be left on the premises? If so, please list the color, make & tag #

Vehicle #1

Vehicle #2

Vehicle #3

Vehicle #4