Are you registering the camera for your home or business?*

Are you registering the camera for your home or business?*

Home

Business

Please provide business/homeowner contact information.

Last Name

 *

Last Name

First Name

 *

First Name

Middle Initial

Middle Initial

Address: Number Street

 *

Address: Number Street

City

 *

City

State

 *

State

Zip Code

 *

Zip Code

Business Name

Business Name

Business Hours of Operation

Business Hours of Operation

Home Telephone

 *

Home Telephone

Business Telephone

Business Telephone

Cellular Telephone

Cellular Telephone

Email Address

Email Address

 Please provide security camera details by answering the questions below: 

Please provide security camera details by answering the questions below:

Number of cameras at location

Describe areas recorded (interior, street view, front yard, etc.)

Image retention period (how long is material kept before deleted?)

Describe reporting period (24/7, business hours, motion activated)

Please provide name of video software used:

Please provide name of video software used:

Is camera monitored by a security company? If yes, please complete the next two questions.*

Is camera monitored by a security company? If yes, please complete the next two questions.*

Yes

No

What is the name of the security company?

What is the name of the security company?

What is the phone number of the security company?

What is the phone number of the security company?

The Simi Valley Police Department would like to thank you for voluntarily providing your private security details. The Simi Valley Police Department commits to you that we will only request access to your security footage during the course of the investigation when we believe a portion of the event occurred in the area of your security cameras. This form can be printed and submitted at the front counter, or mailed to 3901 Alamo Street, Simi Valley, 93063. By default, once submitted the form is electronically sent to the Police Department. If you have any questions, please contact the Police Department at (805) 583-6276 

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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