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2. Please complete this form if you are going on vacation/leaving town and would like the South Jordan Police Department to be aware and help keep your property safe.

   Submitting this request does not remove your responsibility as a homeowner from making every attempt to protect your property while you are away (securing doors/windows, lights on timers, stopping mail/newspaper service, etc). Also, keep in mind that the South Jordan Police Department will make every effort to patrol your property, but only as priority calls or call volume allows. If you have to end your trip earlier than you would have liked, please notify us upon your return to have the checks concluded.

   If you have any questions, please call the South Jordan Police Department at 801-254-4708 (Monday through Friday 8 am to 5 pm) or the Dispatch Center at 801-840-4000 (anytime).

4. First Name*
5. Last Name*
7. Address*
9. City*
10. State*
11. Zip Code*
13. House Description
15. Home Phone*
16. Cell Phone
17. Work Phone
19. Email Address
21. Case Number (If Available)
23. Date of Vacation*
    Date of Vacation Start Date

    —

    Date of Vacation End Date

    If longer than two weeks, please call the Police Department directly.

25. Local Emergency Contact

    Must be a local contact, can list multiple if needed

27. Name
28. Phone
30. Name
31. Phone
33. Name
34. Phone
36. Animals Left at Residence

    Include type and location of pets

    If dogs are on property and outside, patrols will not be conducted in backyards/within fenced areas

38. Vehicles Left at Residence

    Include vehicles in the garage, give a description

40. Lights Left on at Residence or on Timers

    Inside and outside

42. Does your home have an alarm system?*

    1. Yes
    2. No
43. If "Yes", please give local contact information incase of alarm activation:
45. Persons Allowed on Property and Vehicle Descriptions

    Include maid services, ground keepers, family members not traveling, etc.

47. Mail / Newspaper Service Canceled

    1. Yes
    2. No
49. Prior Crime Victim / Threats Made

    1. Yes
    2. No
50. If "Yes", type of crime and suspect information if available:
52. Any Additional Information You Would like to Share
54. Acknowledgment of Terms*

    I agree as a condition of submission to release, defend, indemnify and hold the City of South Jordan, its officers, agents, employees and volunteers harmless from and against any and all loss, judgments, damages, or expenses, arising from or incurred by reason of any claim, lawsuit or action in law or equity, based upon property damage or theft to the property listed on this submission, except to the extent that such injury or damage is directly caused by the negligent acts or omissions of the City of South Jordan, its officers, agents, employees or volunteers resulting from my request for this service.

    1. I have read and acknowledged the terms.
Leave This Blank:


56. 1. Receive an email copy of this form.
57. Email address

    This field is not part of the form submission.

58. Submit

* indicates a required field