Southampton Police Kids Page!

Emergencies Only: 9-1-1
Emergency: (413) 527-1124
Business: (413) 527-1120
Fax: (413) 527-8776
ORI: MA0081600

8 East Street
PO Box 239
Southampton, MA 01073

Vacation Form

The Southampton Police Department has offered the house check program for many years. We are now offering this service online. Please fill in all the fields below and click on SUBMIT.

**You must submit this form at least 48 hours prior to your departure**

If you are departing in less then 48 hours, please come to the station and fill out the traditional form.

Please provide the following contact information:

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Date Submitted	// -- mm/dd/yyyy

Name
Street Address

Work Phone	() -
Home Phone	() -
E-mail

Departure Date:
Departure Time:

Return Date:
Return Time:

Please list anyone that will have a key to your residence:

Key Holders Name:

Relationship to key holder:

Address:


Work Phone:	() -
Home Phone:	() -

Please state the condition of your property when you departed:

Doors and windows locked?

Yes No

Any lights left on timers and if so, what are the times they go on and off?

Yes No

Time on:
Time off:

You will receive an e-mail letting you know that we received your information.