Form Center

2. Camera Registration
4. Name
5. Email Address
7. Address
9. City
10. State
11. Zip Code
13. Phone Number
14. Fax Number
15. Residence or Business*

    1. Residence
    2. Business
17. Camera Views

    1. Street View
    2. Front Yard
    3. Rear Yard
    4. Driveway
    5. Alley

    1. Front Door
    2. Back Door
    3. East Side of Structure
    4. West Side of Structure

    1. North Side of Structure
    2. South Side of Structure
    3. Patio
    4. Parking Lot

    1. Lobby
    2. Hallway
    3. Room/Office
    4. Other (Specify below)
19. Additional Details:
21. Terms of Use:
    If you choose to participate in the program, a crime(s) occurs in your area, and investigators believe your video surveillance may be helpful for investigation of the crime(s), the Eureka 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 and collected from the registrant by the Eureka Police Department. Your voluntary participation in this program shall not be construed as an obligation to release any surveillance video to the Eureka Police Department. Any footage containing or related to criminal activity collected by the Eureka Police Department may be used as evidence during any stage of a criminal proceeding. Under no circumstances shall registrants construe that they are acting as an agent and/or employee of Eureka Government and/or the Eureka Police Department through the program. Under no circumstances shall the Eureka Police Department utilize any information obtained to view footage/feeds directly from cameras owned by registrants. The information you provide regarding your video surveillance system will be for official use only, but may be subject to Open Records requests, or as a witness for any court proceeding as required by law.
23. Terms of Use Agreement*

    1. I understand and agree to the Terms of Use listed above.
Leave This Blank:


25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field