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Vacation Check Request Form

  1. If you live within the Town of Kersey and would like to have vacation checks performed on your residence, please complete this form and submit it to the Kersey Town Hall. You must notify the Police Department immediately if the departure or return dates and times change.

  2. Do you have an alert system?

  3. Are there any indoor or outdoor lights to be left on?

  4. Are there any pets to be left on your property?

  5. Are services to be suspended while you are gone?

  6. The undersigned does hereby grant and request that the Kersey Police Department visually check the property listed above, which may include access to the yard. The undersigned does hereby agree to hold harmless the Town of Kersey, its employees and agents for any claim for personal injury, loss or damage to property that may be suffered by the undersigned or other agents of the undersigned, through any action or lack thereof, by representatives of the Town of Kersey. Further, the undersigned understands and agrees that this is a voluntary free service and does not create a special duty upon the Town and will be provided only as time and personnel are available and no guarantee is made or assurance given against loss, theft or damage to property.

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