BRUCE PENINSULA HOME & COTTAGE SECURITIES
Residents Information:
Date of Request: _______-______-________
Dates: Leave __________-________-________
Return _________-________-________
Name:___________________________________________________
First Last
Address ________________________________________________________
Street
Home:( ) __________-___________
Cell: ( )_________-____________
Emergency Contact Number: ( ) __________
Key Holder/ Contact Information: (IF US WE MUST BE NAMED WITHIN THIS DOCUMENT)
Name:___________________________________________________
First Last
Address:________________________________________________
Street City
Estimated Response Time: (Day)_____________________ (Night):_______________________
Day: ( )__________-____________
Evening: ( )________-_____________
Emergency:( )________-__________
Residential Information:
Alarm:______/_______ If Yes, Company:__________________________
(_____)______-________
Yes No Name Number
Animals:_____/_____ Kind____________ Lights:______/_______/______ IF YES:
Yes No Yes No Timer
Where/When:_____________________________________________
Residential Information:
Alarm:______/_______ If Yes, Company:__________________________(_____)______-________
Yes No Name Number
Animals:_____/_____ Kind____________ Lights:______/_______/______ IF YES:
Yes No Yes No Timer
Where/When:____________________________________________
Any person(s) with Permission to be on your property in your absence:
______________________________________________________
This in no way can guarantee the safety of your property while you are away, but can assure your residence will be checked by Bruce peninsula home & cottage security when possible. If any damage or suspect activity is noted you, and/or the key holder will be notified by the Security Officer for further instructions. By signing and retuning form, you are requesting a residential check of your property. After the return date, this form will be destroyed and no information will be retained. Your signature also releases Bruce peninsula home & cottage security. from any and all liability or blame if you would suffer a loss while you are away.
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