Neighbourhood Watch Application Form
	Neighbourhood Watch Association of St. Albert
	Member Only	Block Captain	Area Leader

Address		Postal Code
Email Address		Residence Phone

	Resident #1	Resident #2
Surname
Given Name
Former Name(s)
Business Phone
Birthdate
Birthplace
Drivers License
	Names Of All Other Residents	And Birthdates
Name		DOB
Name		DOB
Name		DOB
Name		DOB
Name		DOB

Prior to approval of this application, I hereby authorize the Police Force to make an investigation
of their records, or such other investigation as may be deemed appropriate, and on the basis of such
investigations to indicate the approval or disapproval of this application.
CRIMINAL RECORDS WILL NOT BE RELEASED TO ANY PERSON
Signature		Date
please return this application to        RCMP ST. ALBERT   Fax (780) 458-7971
96 Bellerose Drive, St. Albert, Alberta T8N 7A4