2. Community Watch Team Registration Form
   The Community Watch Team is a list of residents interested in receiving resources about how to formally connect with your neighbors, tips on what is and isn’t a suspicious activity, how to prevent crime and safety tips. You can also register your external video camera system here as part of our Community Camera Program. The Coon Rapids Police Department has classified the data I am submitting as non-public or confidential data.
4. First Name*
5. Last Name*
7. Property Type

   1. Residential Home
   2. Apartment Building
   3. Business
9. Home Address*
11. City*
12. Zip*
14. Primary Phone Number*
15. Email address*
    We need this to communicate with you! Please fill in! Thank you!
17. I am interested in registering my external camera system in the Community Camera Program.*
    -- Select One --YesNo
19. May police contact you for video footage?*
    -- Select One --YesNo

    If a crime occurs nearby, and officers are investigating, we may contact you to ask your permission to look at your video footage.
21. Number of Cameras
    -- Select One --N/A12345678910
23. Where Are Your Cameras?

    1. Front Yard
    2. Back Yard
    3. Driveway
    4. Alley
    5. Front Door
    6. Doorbell
    7. Back Door
    8. East side of building

    1. West Side of building
    2. North side of building
    3. South side of building
    4. Patio
    5. Parking lot
    6. Lobby
    7. Hallway
    8. Other (specify below)

    Select all that apply
25. Notes
    (optional)
27. Would you like a Community Watch Team sticker to place on your front door or window?

    1. Yes
    2. No
29. Signature of Submission and Disclaimer:*
    By typing my name in this form I certify that I am voluntarily signing up for the Community Watch Team through the Coon Rapids Police Department. If I am choosing to also sign up for the Community Camera Program, I realize the police department will not be using my camera for active police surveillance and officers will not have direct access to my camera. I realize if crimes occur nearby my address, I may be contacted by police to see if I voluntarily consent to providing my camera footage to assist in an investigation. I understand my name and address information will be maintained in a secure database as a part of the program, which we have classified as non-public or confidential information. I may ask to be removed from the Community Watch Team at any time, and remove my information from the database. I realize if requested, I will receive a Community Watch Team sticker that I may choose to put on my door or window, which may help deter crime and let people know I am a Community Watch Team member.
Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit Submit and Print

* indicates a required field