Block Watch Registration Form - Regional District of Central Okanagan

Required fields are marked with asterisks (*)

Start a Block Watch program in your community

Block Watch brings police and communities together with the common goal of community safety. The inclusive, community-based program involves being alert to your surroundings, talking to neighbours, and being aware of local crime trends and prevention techniques. When neighbours know each other and become familiar with the normal activity patterns within their people can recognize suspicious activity.

The RDCO collects personal information through the Block Watch Registration Form for the purpose of managing applicants. Personal information is collected under the authority of sections 26(c) and 33 of the Freedom of Information and Protection of Privacy Act (FIPPA) and will be used and disclosed only as permitted by that Act.

Questions regarding the collection, use, disclosure, and protection of personal information may be directed to Privacy Officer:
Email: foi.privacy@rdco.com
Phone: 250-763-4918

By submitting an application, you hereby consent to the collection, use and disclosure of your personal data as described in this notice.

What position are you applying for?

Co-Captain

Block Watch Captain

If applying for Co-captain, provide Block Captain's name

Provide name of previous Captain or Co-Captain if replacing them on an existing block

First name

Last name

Date of birth (MM/dd/yyyy)

Place of birth (City, Province)

Driver's licence number

Email address

Home address

City:

Province:

Postal code:

Please list all previous addresses in the past five years with dates

Primary phone number

Secondary phone number

Have you ever been convicted of a criminal offence?

Yes

Employer name

Occupation

All other residents in applicant's home (exlcuding applicant)

First name

Last name

Date of birth (MM/dd/yyyy)

Place of birth (City, Province)

Drivers licence number

First name

Last name

Date of birth (MM/dd/yyyy)

Place of birth (City, Province)

Drivers licence number

First name

Last name

Date of birth (MM/dd/yyyy)

Place of birth (City, Province)

Drivers licence number

Number of homes being organized

If in a complex, provide complex name

Document upload section

Please provide a photo of legal photo identification (e.g. Driver's Licence, Personal Health Card, Passport, etc.)

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Allowed extensions pdf, doc, docx, jpg, jpeg, gif, png, tif

I, the undersigned, hereby authorize the RCMP to inquire and determine whether or not I have ever been investigated, charged or convicted of a criminal offence. I further authorize the RCMP to obtain a full and complete disclosure of all facts uncovered. I have provided the above information for such an inquiry and affirm that I am of good character. The RCMP reserves the right to revoke Block Watch status.

Applicant signature

Clear