Alarm System Permit Application

The City of Conway, Arkansas passed City Ordinance O-16-45 requiring a permit be obtained for any residence or business with an alarm system installed therein. Any property owner or lessee of property of this city may apply, at no charge, here or in person at the Conway Police Department.

Note: This application includes a consent to search the alarmed premises for intruders. By submitting this form electronically, you acknowledge that you have the right to refuse to give this consent. Please read the consent carefully before sending the form.

Applicant Information
Permit Type

Permit Type Business Residential
Application Type

Application Type New Update Existing Permit
Will this permit replace an active permit you hold at a previous address?

Will this permit replace an active permit you hold at a previous address? Yes No N/A
If you are replacing or updating an existing permit, what is the Current Permit Number (if known)?
Previous Permit Address Previous Permit Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Current Permit Address Current Permit Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Contact Info
Alarm User (Primary Contact) Alarm User (Primary Contact) First Last
Business Name
Email
Date of Birth Date of Birth / MM / DD YYYY
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Home Phone (with area code) Home Phone (with area code) - ### - ### ####
Cell Phone (with area code) Cell Phone (with area code) - ### - ### ####
Work Phone Work Phone - ### - ### ####
Fax (with area code) Fax (with area code) - ### - ### ####
Mailing Address (if different) Mailing Address (if different)
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Alarm Information
Alarm Type
System Status
Installation Date Installation Date / MM / DD YYYY
Alarm Style
Name of Alarm Monitoring Company
24-Hour Telephone
Additional Contact Information

List up to four persons other than those listed above who can be contacted with keys to the premises to assist police or fire department to secure the premises or reset a malfunctioning alarm.
Emergency Contact (A) Name Emergency Contact (A) Name First Last
Emergency Contact (A) Home Phone Emergency Contact (A) Home Phone - ### - ### ####
Emergency Contact (A) Cell Phone Emergency Contact (A) Cell Phone - ### - ### ####
Emergency Contact (A) Work Phone Emergency Contact (A) Work Phone - ### - ### ####
Relationship of Emergency Contact (A) to Applicant
Emergency Contact (B) Name Emergency Contact (B) Name First Last
Emergency Contact (B) Home Phone Emergency Contact (B) Home Phone - ### - ### ####
Emergency Contact (B) Cell Phone Emergency Contact (B) Cell Phone - ### - ### ####
Emergency Contact (B) Work Phone Emergency Contact (B) Work Phone - ### - ### ####
Relationship of Emergency Contact (B) to Applicant
Emergency Contact (C) Name Emergency Contact (C) Name First Last
Emergency Contact (C) Home Phone Emergency Contact (C) Home Phone - ### - ### ####
Emergency Contact (C) Cell Phone Emergency Contact (C) Cell Phone - ### - ### ####
Emergency Contact (C) Work Phone Emergency Contact (C) Work Phone - ### - ### ####
Relationship of Emergency Contact (C) to Applicant
Emergency Contact (D) Name Emergency Contact (D) Name First Last
Emergency Contact (D) Home Phone Emergency Contact (D) Home Phone - ### - ### ####
Emergency Contact (D) Cell Phone Emergency Contact (D) Cell Phone - ### - ### ####
Emergency Contact (D) Work Phone Emergency Contact (D) Work Phone - ### - ### ####
Relationship of Emergency Contact (D) to Applicant
Consent to Search and Waiver of Right to Refuse to Give Consent

By submitting this form, I consent to the search of the alarmed premises by the Conway Police Department for intruders if the Alarm Monitoring Company requests police assistance in responding to the alarm at the alarmed premises or, if this is an ‘audible-only’ alarm, if the audible alarm is sounding. This consent shall remain in effect while the permit is in effect.

BY SUBMITTING THIS FORM I UNDERSTAND THAT I HAVE THE RIGHT TO REFUSE TO GIVE THIS CONSENT.

• I understand that under the Arkansas and United States Constitutions, I have a legally protected right against a warrantless entry or search of my home. I understand this right to mean that law enforcement personnel may not enter or search my home without a warrant or exigent circumstances.
• I understand that I have a right to refuse this request for consent to search my premises.
• I waive for myself and for all others living in my home, this Constitutional right against a warrantless entry or search of my home.
• I consent and authorize members of the Conway Police Department to, in my absence, enter or search my home in for intruders if the Alarm Monitoring Company requests police assistance in responding to the alarm at the alarmed premises or, if this is an ‘audible-only’ alarm, if the audible alarm is sounding.
• I understand that I may terminate this Waiver and Consent at any time by simply notifying the Conway Police Department in writing.
I agree to the consent form above.

I agree to the consent form above. Yes No
Name Name First Middle Last
Type your full name to confirm the selected choice above.

Alarm System Permit Application

Alarm System Permit Application

Applicant Information

Contact Info

Alarm Information

Additional Contact Information

Consent to Search and Waiver of Right to Refuse to Give Consent