2. First Name*
3. Last Name*
5. Street Address*
7. City*
8. State*
9. Zip Code*
11. Phone Number
    A mobile number is required to receive text alerts.
12. Would you like to receive text alerts?
    -- Select One --YESNO
13. Email Address*
15. Which SHIELD Program best describes your partnership with the Hanover County Sheriff's Office?

    1. Neighborhood Watch Coordinator
    2. Business Watch Partner
    3. Retail Business Partner
    4. Hospitality Industry Partner
    5. Financial Services Partner
    6. Pharmacy/Pharmaceutical Services Partner
    7. Healthcare Industry Partner
    8. Worship Watch Partner
    9. Private Security Partner
    10. Critical Infrastructure Partner
    11. Educational Services Partner
    12. Law Enforcement Partner
    13. General SHIELD Partner (Other)

17. Please provide the name of the Organization/Business/Church/Neighborhood you are affiliated with below. If not applicable please enter N/A.  Thank you.

19. Organization/Business/Church/Neighborhood Name*
21. Business Address
23. City
24. State
25. Zip Code
27. Business Phone
29. Camera Survey (optional)
    Does your property have a security camera? If yes, please complete the information below. This information can assist the Sheriff's Office in solving crimes more quickly in your community. **Providing this information is completely voluntary and by providing this information you WILL NOT be giving the Sheriff's Office access to your cameras. You will simply be letting us know the cameras exist so that we can reach out to you if a crime happens in your area.
31. Primary Contact
    Enter the name of the person whom investigators will contact.
32. Phone Number
    Enter the phone number of the primary contact.
34. Email Address
    Enter the email address of the primary contact.
36. Security Device Address
    Enter the address of the security device.
37. Camera Location

    1. Front of Property
    2. Back of Property
    3. Side of Property

    Check the boxes of where the camera(s) can see.
39. Share Security Device Location

    1. I agree

    By checking this box, you agree to share your security device's location with the Hanover County Sheriff's Office and understand that you may be contacted in the future by the Hanover County Sheriff's Office if needed. This DOES NOT give the Hanover County Sheriff's Office access to your security device, only it's location.
Leave This Blank:


41. Submit

* indicates a required field