Safe House Application: For Businesses

All online applications will be submitted to the Safe House program coordinator, the Police Community Liaison with the Dallas Police Department. Once your application has been submitted, processed and approved, the Safe House coordinator will reach out to set up your Safe House visit!

form.antibot { display: none !important; } You must have JavaScript enabled to use this form.

About the Business

Business Name: *

Business Address: *

Business Phone Number: *

About the Business Owner

First Name: *

Last Name: *

Maiden Name:

Residential Address: *

Date of Birth: *

Sex: *

ODL: *

Phone Number: *

Please List All Employees:

Full Name:

Date of Birth:

Residential Address:

Sex:

ODL:

Phone Number:

Full Name:

Date of Birth:

Residential Address:

Sex:

ODL:

Full Name:

Residential Address:

Sex:

ODL:

Date of Birth:

Full Name:

Date of Birth:

Residential Address:

Sex:

ODL:

As a volunteer for the Safe House program, I hereby authorize the Dallas Police Department to conduct a background investigation to determine the qualifications of this business to participate in this program. (E-Signature and Date below)

Business Owner Signature: *

Date:

edit-submitted-date-month

edit-submitted-date-day

edit-submitted-date-year

Comments

Safe House Application: For Businesses

Contact Information

Thomas Simpson

Chief of Police

Upcoming Events