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2. Registration Type*
   -- Select One --BusinessResidenceSchool
4. Business Name (If Applicable)
6. Camera Type (Ring, Blink, Nest, etc.)
8. Camera Address*
10. City*
11. State*
12. Zip Code*
14. First Name*
15. Last Name*
17. Address*
19. City*
20. State*
21. Zip Code*
23. Email Address*
24. Phone Number*
26. Main Contact Person*
27. Main Contact Phone Number*
29. Alternate Contact Person*
30. Alternate Contact Phone Number*
32. Does someone on-site know how to work the system?
    -- Select One --YesNo
34. Recording Period
    -- Select One --24/7Designated HoursMotionStill Images
36. Do the cameras show any areas outside of the home or business?
    -- Select One --YesNo
38. Please describe the area your camera can record.
42. DISCLAIMER & TERMS OF USE

    The goal of the Safe-Cam program is to deter crime and promote public safety through collaboration between the Upper Providence Township Police Department and the community we serve. Accordingly, all Safe-Cam registrants agree to the following terms and conditions:

    1. Any footage containing or related to criminal activity may be collected by the Upper Providence Township Police Department for use as evidence during any stage of a criminal proceeding.
    2. Relevant information is reserved for official use by the Upper Providence Township Police Department and will not be released to any member of the general public or press.
    3. If necessary, the Upper Providence Township Police Department will contact you directly, using the information provided to request the appropriate video surveillance footage.
    4. Under no circumstances shall registrants construe that they are acting as an agent and/or employee of the and/or the Upper Providence Township Police Department through the Safe Cam program.
    5. Under no circumstances shall the Upper Providence Township Police Department utilize any information obtained to view footage/feeds directly from cameras owned by registrants.

    Registration into the program indicates acceptance of the above terms and conditions.

    
    
44. By clicking this button I agree to the Terms and Use of the form.
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46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit

* indicates a required field