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Vacation Notification Instructions:
In the event you are going to be away on vacation, please let the Department of Public Safety know, so that we may be prepared for any emergencies at your residence and can conduct property checks as needed. Please contact the Public Safety Department In the event your absence will be extended or you return home early. Once you have completed the online form please submit electronically or print and fax, mail, or drop off the form at the Department of Public Safety.
Address1*
Date/Time of Departure*
Date/Time of Departure
Date/Time of Departure
Date/Time of Return*
Date/Time of Return
Date/Time of Return
Your First Name*
Your Last Name*
Phone*
Cell
Other / Email
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If you have a burglary or fire alarm system that is monitored by a private vendor, please supply your “contact person” on the notification form with the phone number for the alarm company and password for the alarm system. If you have an audible alarm, please instruct your “contact person” how to reset or disable the alarm should there be an activation of the alarm. This may prevent unnecessary, repeated responses from police and fire units should there be trouble with the alarm system. This will also allow the alarm system to be reset if activated.
First Name*
Last Name*
Address1*
City
State
Zip
Phone*
Cell
Other/Email
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Please let us know if there are any pets, materials, or objects that may pose a special concern to public safety officers or firefighters should they responded to your residence.
Will there be any lights left on?*
1. Yes
2. No
Location of lights:
Are there any pets in the home?*
1. Yes
2. No
Pet Type and Name:
Are there any vehicles being left at your home?*
1. Yes
2. No
Vehicle description and location (e.g. driveway, garage, roadway):
Additional Information
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Waiver*
By selecting "Agree" and submitting this form, I am indicating that I understand that the Charter Township of Pittsfield, its’ Department of Public Safety, employees and agents are not assuming responsibility for the property that I represent. I agree to hold Pittsfield Township harmless from any action or inaction pursuant to my notification that I will be absent from the listed property. Further, I understand those identified above are not assuming additional liability as a result of my notification and I will not hold them responsible.
1. Agree
2. Do not agree

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