KEY KEEPER PROGRAM
The Berlin Police Department, in cooperation with the Berlin Senior Center, invites you to become a part of the Key Keeper Program. Please submit the following information to the Berlin Police Department at 240 Kensington Road, Berlin, CT 06037.

Name_______________________________Phone_________

Address___________________________________________

__________________________________________________

Emergency Contact: __________________Phone_________

Alarm System/Name:__________________Phone_________

Pets in Home:___________Medical Condition:_____________

Vehicle/s: Make/Model_______________________________

License Plate # _____________________________________

Special Information: _________________________________


In the event of an emergency, when family, friends or neighbors can’t be reached, I authorize the Berlin Police Department to assist and /or check on me. They may keep on file the above information, along with my house and/or car keys.


Signed:__________________________________Date:_____