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2. First Name*
3. Last Name*
5. Business Name (Optional)
7. Address Number*
8. Street Name*
10. City*
11. State*
12. Zip*
14. Phone Number*
15. Email Address*
17. Best way to reach you*

    1. Phone
    2. Email
18. Number of Cameras*
    -- Select One --12345+
19. How many days are images or videos stored?*
21. Additional information you would like to share (Optional)
23. Consent*

    You will only be contacted by the Frederick Police Department in the future if there is a criminal incident in the vicinity of your security camera. Police personnel, if necessary, may request a copy of any video captured by your camera, which may assist in the investigation of a crime. Terms of Use: The goal of the program is to deter crime and promote public safety through collaboration between the Frederick Police Department and the communities we serve. Accordingly, all registrants agree to the following terms and conditions: 1. Any footage containing or related to criminal activity may be collected by the Frederick Police Department for use as evidence during any stage of a criminal proceeding. 2. Under no circumstances shall registrants construe that they are acting as an agent and/or employee of the Town of Frederick and/or the Frederick Police Department through the program. 3. If necessary, the Frederick Police Department will contact you directly, using the information provided on this site, to request the appropriate video surveillance footage.

    1. By submitting this information, I understand and agree to the above policy and terms of use
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25. 1. Receive an email copy of this form.
26. Email address

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