Request an extra Patrol - City of Happy Valley

Request for Extra Patrols (Three weeks maximum) If you own residential property or a business within the City of Happy Valley and would like to have extra patrols performed, please complete this form and submit to The City of Happy Valley at least 72 hours prior to your planned absence.

Owner Information

Name

First Last

Street Address ZIP Code

Phone

Email

Date Leaving

Date Returning

Will paper, mail & deliveries be stopped?*

Yes
No

Will lights be left on?*

Yes
No

Will lights be on a timer?*

Yes
No

If lights are on, which room/rooms?

Will pets be at home?*

Yes
No

Type of pet

Pet is

Indoor
Outdoor

Who will be caring for the animals?

Please provide name, address & phone number

Vehicle Information

List vehicle which will be at the property

Year	Make	Model	Plate

Emergency Contact

Have you let a neighbor, friend or relative know how to contact you in case of an emergency?*

Yes
No

Contact name

First Last

Address

Street Address City State / Province / Region ZIP / Postal Code

Phone

Does this person have a key to your property?*

Yes
No

Do you have an alarm system?*

Yes
No

Monitoring Company*

Monitoring Company Phone #*

Additional Information

Please list any additional information we should be aware of

Authorization and Waiver

The undersigned does hereby grant and request the City of Happy Valley and its Officers to check upon the property listed above. The undersigned does hereby agree to hold harmless the City of Happy Valley; its employees, and agents for any claim for personal injury, loss or damage to property that may be suffered by the undersigned, through any action or lack thereof, by a representative of the City of Happy Valley. Further, the undersigned understands and agrees that this is a voluntary, free service and does not create a special duty upon the City, will be provided only as time is available, and no guarantee is made nor assurance given against loss, theft, or damage to premises. The undersigned does hereby agree to secure the premises when leaving and take whatever security measures at his/her disposal to cooperate in preventing crime, fire or other incidents from occurring. The undersigned has noted any conditions that will assist the City staff during these checks and will notify the City of Happy Valley upon return.

Signature*

City Hall

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How Do I?

Request for extra Patrol

Request for Extra Patrols (Three weeks maximum) If you own residential property or a business within the City of Happy Valley and would like to have extra patrols performed, please complete this form and submit to The City of Happy Valley at least 72 hours prior to your planned absence.

Owner Information

Vehicle Information

Emergency Contact

Additional Information

Authorization and Waiver

City of Happy Valley

Government

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16000 SE Misty Drive, Happy Valley, OR 97086

(503) 783-3800 | [email protected]