Mission Statement Organizational Chart Block Captain Application Neighborhood Watch Name of neighborhood, subdivision or home-owners' association:(Required) Which homes are in your group? (List addresses or attach map for larger areas.) FileMax. file size: 400 MB.Name(Required) First Last Address(Required) Street Address City State ZIP / Postal Code Date of Birth:(Required) MM slash DD slash YYYY Cell Phone or Home #:Work Phone:Email Release of Information(Required) I understand that all available police and criminal records will be used to determine my eligibility to serve as a Neighborhood Block Captain. I understand that the investigation is being done solely to protect community members that require the services of a Neighborhood Block Captain. I understand that any criminal/police records of mine will remain confidential as required by Stated and Federal Law. I also authorize the Greeley Police Department to share my contact informationwith other neighborhood residents who need to contact me. I understand that my contact information will not be provided for marketing or political solicitation purposes.Electronic Signature(Required) Today's Date(Required) MM slash DD slash YYYY Block captain application captcha
