DO YOU WISH TO WOULD YOU WOULD SUBSCRIBE TO

DATE:
BLOCK CONTACT:
Legibly complete this form for the households that are participating in Neighborhood Watch. Submit the completed list to the Crime Prevention Officer at your initial meeting to get your Neighborhood Watch group started. We will provide you with copies for each participant.
It is important to update the list at least annually. Updates should also be done when a new neighbor joins or if a neighbor moves from
the block. Please call us if you have any questions.
LAST NAME
FIRST NAME(S)
ADDRESS
HOME
PHONE
MOBILE
PHONE
EMAIL
DO YOU WISH TO
SUBSCRIBE TO
THESE
ELECTRONICALLY?
NEWSLETTER
F:COMMON\CRT\Crime Prevention\CP PROGRAMS\Neighborhood Watch\BC Packet Items\Block Contact List.frm.pub
JJL/amh 1/2005; upd amh 1/2008; 8/2009
CRIME
NET
WOULD
YOU LIKE
A HOME
SECURITY
SURVEY?
WOULD YOU
LIKE TO BE
CONTACTED
ABOUT YOUR
NEIGHBORHOOD
ASSOCIATION?
The information contained on this sheet is intended for use only by the neighbors listed above and strictly
for the purposes of participating in the Salem Police Department Neighborhood Watch program.