Form Center

2. Description
   Residential Camera Program Signup Form By filling out this form, you agree to allow the City of Ellisville Police Department to contact you regarding your security camera. Once your camera is registered, The Ellisville Police Department will only contact you if a criminal incident occurred near your security camera and police believe viewing your video footage will assist in the investigation.
3. 
5. Address and camera locations available
7. Residential or Business*

   1. Residential
   2. Business
9. Address1*
11. City*
12. State*
13. Zip Code*
15. What areas do the cameras cover? (select all that apply)*

    1. Front entry area
    2. Back entry area
    3. Side yard area
    4. Street, parking, or vehicle area
    5. Other area
17. Do you have live feed?*

    1. Yes
    2. No
19. Is your storage stored locally or in the cloud
    -- Select One --LocallyCloud
21. How long is the video stored
    -- Select One --1-5 Days6-14 Days14-30 Days30+ DaysUnknown
23. Primary and secondary contact information
25. Contact (Primary)*
26. Phone Number*
    Primary
28. Email (Primary)*
30. Contact (Secondary)
31. Phone Number
    Secondary
33. Email (Secondary)
35. Terms and Conditions*

    1. I agree to the terms and conditions
37. The information you provide regarding your camera systems will be for official use only. Your personal information will remain confidential and not be distributed except as required by law or court order. This program is entirely voluntary and you can withdraw consent to view video footage from your camera system at any time by calling the Ellisville Police Department. If necessary, the Ellisville Police Department will contact your directly, using the information provided by you at the time of registration, to request the appropriate video surveillance footage. Any footage containing or related to criminal activity collected by the Ellisville Police Department may be used as evidence during any stage of a criminal proceeding and registrants could be subject to a court subpoena. Under no circumstances shall the registrants construe that they are acting as an agent and/or employee of the City of Ellisville or Ellisville Police Department through the program.
Leave This Blank:


39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit

* indicates a required field