Neighborhood Watch Application

Congratulations of your decision to join your neighborhood watch.  Please fill out the information below, as you want it to appear on a mailing label.  The information will be given to your neighborhood watch captain to be used to disseminate information to you.  If you have decided to become a neighborhood watch captain, check the "yes" box under Block Captain.

Please provide the following information:                                                                           

First Name
Last Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Home Phone
E-mail

Would you like to be a Block Captain?

Yes
No

Today's Date:


Any further comments?


Seville Police Department
Copyright © 2002  Seville Police Department.  All rights reserved.
Revised: 01/10/08