S.C.R.A.M.

2. 

4. Contact Information

6. First Name*

7. Last Name*

9. Business Address:

   if applicable

11. Street Address:*

    Location of Cameras

13. City:*

14. State:*

15. Zip:*

17. Email Address:

18. Phone:*

20. Camera Information

22. Number of Cameras:*

24. Location*

    Select all that apply

    1. Front Yard
    2. Back Yard
    3. Driveway
    4. Alley

    1. Front Door
    2. Back Door
    3. Street
    4. Patio

    1. Parking Lot
    2. North Side of Property
    3. South Side of Property
    4. West Side of Property

    1. East Side of Property
    2. Lobby
    3. Hallway
    4. Rooms/Office
26. Other Locations:

28. Acknowledgement
    If necessary, the Storm Lake Police Department will contact you directly, using the information provided by you at the time of registration, to request the appropriate video surveillance footage. Any and all video surveillance footage shall remain the property of the registrant until it is requested by the Storm Lake Police Department and collected from the registrant by the Storm Lake Police Department. Your voluntary participation in this program shall not be construed as an obligation to release any surveillance video to the Storm Lake Police Department upon request. Any footage containing or relating to criminal activity collected by the Storm Lake Police Department may be used as evidence during any stage of a criminal proceeding.

    If necessary, the Storm Lake Police Department will contact you directly, using the information provided by you at the time of registration, to request the appropriate video surveillance footage. Any and all video surveillance footage shall remain the property of the registrant until it is requested by the Storm Lake Police Department and collected from the registrant by the Storm Lake Police Department. Your voluntary participation in this program shall not be construed as an obligation to release any surveillance video to the Storm Lake Police Department upon request. Any footage containing or relating to criminal activity collected by the Storm Lake Police Department may be used as evidence during any stage of a criminal proceeding.

30. Under no circumstances shall registrants construe that they are acting as an agent and/or employee of the City of Storm Lake and/or the Storm Lake Police Department through the program. Under no circumstances shall the Storm Lake Police Department utilize any information obtained to view footage/feeds directly from cameras owned by the registrant.

    Under no circumstances shall registrants construe that they are acting as an agent and/or employee of the City of Storm Lake and/or the Storm Lake Police Department through the program. Under no circumstances shall the Storm Lake Police Department utilize any information obtained to view footage/feeds directly from cameras owned by the registrant.

32. Signature*

33. Date
    Date

Leave This Blank:


35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

* indicates a required field