Extra Patrol Request

The Coopertown Police Department offers Extra Patrol to all citizens and businesses within the limits of the Town of Coopertown, Tennessee. Residents and businesses who want a police officer to patrol their property more frequently because of a special circumstance or issue could benefit from this service. After reading the information below, kindly fill out this form.

IF THIS REQUEST IS REGARDING AN EMERGENCY SITUATION THAT IMMEDIATELY THREATENS LIFE, LIMB, OR PROPERTY, STOP THIS REQUEST AND CALL 911 IMMEDIATELY!

By checking this box, I affirm this Extra Patrol Request is not related to an emergency situation that immediately threatens life, limb, or property. I understand that if it this was related to an emergency, I should stop this request and should immediately call 911.

Please read and acknowledge understanding

When submitting forms over the internet, there is always the risk that information provided can be viewed by someone else. The Coopertown Police Department takes normal precautions to protect data, and we only ask for the minimal information necessary to process your request. However, you are submitting this data with the understanding that we cannot guarantee this information will not be intercepted. If you do not prefer to submit this form online, you can visit us at 5153 Burgess Gower Rd, Springfield, TN 37172 or call the police department at (615) 382-7007.

Please enter the name, e-mail address, and phone number of the person making the Extra Patrol Request.
Full name of person submitting this request
E-mail address of requestor
United States +1
Phone number of requestor.
Describe the location, dates, and details of the extra patrol

Jurisdiction
By checking, you are verifying that this address is located in the municipal limits of the Town of Coopertown and Coopertown Police Department officers patrol the area near your home or business. 

Please list any pertinent information regarding the Extra Patrol Request (ex. will any lights be left on, what vehicles left in driveway, etc)
Please read and acknowledge

Please read the following statement before submitting this form. The Coopertown Police Department, per your request, will attempt to check your residence periodically. Neither the Town of Coopertown, Tennessee, nor the Coopertown Police Department, assumes any liability in the event of theft, loss or damage to personal or real property in or around your residence. By submitting this form, it is understood and agreed neither the Town of Coopertown, Tennessee, nor the Coopertown Police Department, assumes any liability with the "Extra Patrol Request." The resident, by accepting the "Extra Patrol Request," and by execution of this request understands and agrees to the provisions of this release.

The Coopertown Police Department makes every effort to check every security check request we have on file. However, due to our response to other calls for service, we cannot guarantee the security of your property on an individual basis. If you are going to be away, you should take every precaution to secure your property in your absence.

I certify that I am the owner or caretaker of the property described above, and that the information provided is to the best of my knowledge. I further understand this information is being transmitted over the internet and could be subject to interception by third parties and could be delayed or not delivered due to technical errors. I further understand that the Coopertown Police Department may make reasonable efforts to fulfill this Extra Patrol Request, but cannot guarantee my property will be checked with regularity, if at all, under this program due the possibility that higher priority requests for service could interfere.