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2. Owner/Renter First and Last Name*
4. Address*
6. Phone Number*
7. Email Address
9. Departure and Return Date/Time*
   Departure and Return Date/Time Start Date

   Departure and Return Date/Time Start Time

   —

   Departure and Return Date/Time End Date

   Departure and Return Date/Time End Time
11. Security Alarm *

    1. Yes
    2. No
12. Backyard Accessible*

    1. Yes
    2. No
14. Lights On Inside*

    1. Yes
    2. No
15. Lights On Outside*

    1. Yes
    2. No
17. Vehicles on Property*
    Please list the number of vehicles that are on the property, along with the vehicles' make, model, color and license plate information.
21. Emergency Contact Name*
23. Phone Number*
25. Address*
29. Other Information
31. Owner/Renter Signature*
    I UNDERSTAND THAT THE RRPD, AS A PUBLIC SERVICE, WILL ATTEMPT TO CHECK MY HOME AT LEAST ONCE EACH DAY DURING MY ABSENCE AND THAT NO GUARANTEE OF SECURITY IS MADE OR IMPLIED. I ALSO GRANT APPROPRIATE MEMBERS OF THE RRPD PERMISSION TO ENTER MY HOME IN THE EVENT OF AN EMERGENCY OR IF A BREACH OF SECURITY IS SUSPECTED. I AGREE TO ASSIST RRPD IN THE PROSECUTION OF ANY PERSONS FOUND UNLAWFULLY ON MY PREMISES.
32. Date*
    Date
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34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field