Glendale, AZ - Police - Neighborhood Watch Form

Your Name:
Complete Address:
Position:	Captain Co-Captain
E-mail address:
Secondary E-mail address:
Home phone:
Best time to call:
Work phone:
Best time to call:
Cell phone:
Best time to call:
Pager:
Fax:
The Glendale Police has my permission to release my name, address and phone number to any of the following checked persons or entities:	Residents in my Neighborhood Watch Area Other Neighborhood Watch Captains City of Glendale Departments (Mayor, City Council, Fire, etc.)
Association Name:
Number of homes in your neighborhood watch area:
Number of homes participating in the watch area:
Your neighborhood watch area has metal neighborhood watch signs:	Yes No
If yes, please give sign locations:
Your neighborhood is a registered neighborhood with community partnerships:	Yes No
If your neighborhood watch group has had activities or events in the past, please provide dates:
Please provide your initials as a form of electronic signature:
Date:
Please provide the name of your watch group's co-captain or captain for the purposes of matching records:
Co-captain or captain's e-mail address: