Vacation/Extra Patrol Form

Complete the official form online. A completed PDF will be sent to department administration and returned to you for printing.

Not for emergencies. Call 911 when immediate police, fire, or medical assistance is needed.

Vacation / Extra Patrol Request

This request informs the Harrisburg Police Department that a residence, business, or other property may require additional patrol attention. Submission does not guarantee continuous surveillance or create a guarantee of protection.

Requestor Information

Full NameProperty Address

CityStateZIP

Primary PhoneEmail for ConfirmationA completed copy and confirmation number may be sent to this address.

Best Time to Contact *

Select all that apply.

MorningAfternoonEvening

Patrol Request Information

Location Type *

ResidentialBusinessOther

Other Location Type

Reason for Extra Patrol *

Select all that apply.

VacationBusiness will be vacantResidence will be vacantOther

Other Reason

Patrol Start DatePatrol Start Time

Patrol End DatePatrol End Time

Emergency Contact

Emergency Contact NameRelationship

Emergency Contact PhoneAlternate Phone

Property Information

Property Details

Select all that apply.

Alarm systemExterior lightsInterior lights or timersPets at propertyVehicles remainingNeighbor or caretaker has a keyAuthorized persons may enter

Vehicles Remaining at the PropertyAuthorized Persons or Caretakers

Special Instructions for Officers

Special InstructionsDo not enter sensitive financial information, passwords, Social Security numbers, or unnecessary medical information.

Certification and Electronic Signature

Type Your Full Name as Your SignatureYour typed name must match the full name entered at the beginning of this form.I certify that the information provided in this Vacation / Extra Patrol Request is true and accurate to the best of my knowledge. I understand that my typed name serves as my electronic signature. I also understand that submitting this request does not guarantee continuous surveillance or create a special duty or guarantee of protection by the Harrisburg Police Department.

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Harrisburg Police Department

202 N East St, Harrisburg, AR 72432

Harrisburg, Arkansas

Emergency: 911

Non-Emergency: (870) 578-2530

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