Vacation Watch Request Form

This form is used to notify the Butler Police Department of your upcoming vacation. Our department will make every effort to make as many checks on your residence as time and workloads allow. The Butler Police Department and the City of Butler do not assume any liability for loss or damage to property during the specified dates.

All fields marked with * are required.

Resident Information


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Local Emergency Contact Information


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Persons Authorized on the Property





Vehicles Left on Property


Vehicle 1


Vehicle 2


Vehicle 3


Vehicle 4




Pets Left at the Residence





Additional Questions








Please Read And Complete


I am submitting this request to notify the Butler Police Department that I will be out of the city and my residence will be unoccupied for the time period that I listed on this request. I agree that I will immediately notify the Butler Police Department of my return in order for this request to be cancelled. I also give permission for members of the Butler Police Department to enter onto my property to conduct these checks of my residence and if necessary, to enter the premises in the event of an emergency such as an open door, window, etc. or some other exigent circumstances. I understand that members of the Butler Police Department will make checks of my residence and exercise due diligence to prevent crime and insure that my property is secure. I also understand that no measure can always be totally effective against crime and agree to hold the Butler Police Department and the City of Butler and its members harmless in the event of circumstances beyond their control, which results in damage to or loss of my property.


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