“Friends of The Heights”

Neighborhood Crime Watch Program

Sign Up Sheet

 

Principal Occupant: ____________________________________________________________

                                    First Name                              Last Name

 

Home Phone Number: _____________________     Cell Phone Number: _________________

 

E-Mail Address: ______________________________________________________________

 

Address:  ____________________________________________________________________

                 House #               Street Name

 

Other Occupants:

Relationship      First Name                Last Name                   Cell #               E-Mail Address

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

 

Automobiles:  (Optional)

            Make               Model              Year    Color               License Plate #            State

1. ____________________________________________________________________________

2. ____________________________________________________________________________

3. ____________________________________________________________________________

4. ____________________________________________________________________________

 

Have you identified your property in case it is lost, stolen, or damaged? (Optional)

____ Yes         ____No           If yes, how?_____Engraving   _____Ink Marking     ____Other

Do you have an alarm system in your home?    _____Yes        _____No

If yes, type of alarm system(s):   ____Silent   ______Audible

If yes, is it monitored?   _____Yes      _____No        If monitored what is the name of your alarm company? _____________________________________________________________________

 

I, _________________________________ am interested in and committed to participating in a

     (Signature)

Neighborhood Crime Watch Program for The Heights of Jupiter.

 

I will serve as (please check the boxes next to the position)

                     Chairperson for The Heights of Jupiter Crime Watch Program

                     Co-Chairperson for The Heights of Jupiter Crime Watch Program

         Street Coordinator for ____________________________ street for The Heights of Jupiter Crime Watch Program

Please fax or e-mail this completed form to:  Kristi Coleman, Jupiter Police Department, Police Officer/Community Activities Unit at fax: 746-4545, e-mail: kristic@jupiter.fl.us.