Holiday Housecheck Form

Boundaries

We are accepting registration from houses bounded by York St. to the North, Ontario St. to the East, King St. to the South, and Sir John A. MacDonald Blvd. to the West. If you live outside these boundaries and would like to inquire about special arrangements, please contact the Municipal Affairs Commissioner (mac@ams.queensu.ca).

Registrant's Address *
Your answer
Closest Intersection *
Your answer
Registrant's name *
Your answer
Registrant’s Kingston phone # *
Your answer
Registrant’s Winter phone #
Your answer
Registrant's email address *
Your answer
Landlord’s name *
Your answer
Landlord’s phone # *
Your answer
Other contact’s name(s)
Your answer
When is the last person in your house leaving? *
Your answer
In the event of a suspected incident, please indicate who you would like to be contacted by telephone by a Holiday Housecheck representative *
Required
On behalf of the residents of this dwelling, I agree to the Terms of this Agreement as listed above *
Required
I acknowledge that the sole intention of the Holiday Housecheck program is to seek to reduce the probability of break-ins during the winter holidays. The service may not prevent incidents from occurring during my absence *
Required
I, therefore, release and hold harmless the Alma Mater Society of Queen’s University and its employees and volunteers for any and all liability *
Required
Additional instructions
Your answer
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