Alarm System Permit

The City of Conway 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.

Permit Type*

Business Residential Select permit type

Business Name*

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Alarm User (Primary Contact):*

Please enter the Primary Contact's name.

Email:*

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Date of Birth:*

Please select your Date of Birth. If calendar isn't visible, enter DOB manually (mm/dd/yyyy).

Street Address:*

Please provide the number (house/apt. number).

City:*

Please enter city.

Zip Code:*

5-Digit Zip Code Required

Nearest Cross Street:

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Home Phone (with area code):*

Please enter your phone number in the correct format. 123-456-7890

Cell Phone (with area code):

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Work Phone:

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Fax (with area code):

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Mailing Address (if different):

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City, State, Zip:

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Alarm Type:*

Select One Alarm Type

Type of Residence

Select One Alarm Type

System Status:*

Select One

Installation Date:*

Please enter an approximate date.

Alarm Style:*

Choose One

Name of Alarm Monitoring Company:

Please enter the alarm company's name.

24-Hour Telephone:

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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.

Contact Name*

Please enter the contact's name.

Home Phone*

Please enter a phone number.

Cell Phone

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Work Phone

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Relationship to Applicant*

Please enter your relationship.

Contact Name

Please enter the contact's name.

Home Phone

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Cell Phone

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Work Phone

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Relationship to Applicant

Please enter your relationship.

Contact Name

Please enter the contact's name.

Home Phone

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Cell Phone

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Work Phone

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Relationship to Applicant

Please enter your relationship.

Contact Name

Please enter the contact's name.

Home Phone

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Cell Phone

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Work Phone

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Relationship to Applicant

Please enter your relationship.

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.

Proof of Life*

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Applicant Information

Alarm Information

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) Information

Emergency Contact (B) Information

Emergency Contact (C) Information

Emergency Contact (D) Information

CONSENT TO SEARCH AND WAIVER OF RIGHT TO REFUSE TO GIVE CONSENT

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

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