CITY OF LA MIRADA

NEIGHBORHOOD WATCH ACTIVITY SURVEY 

Name: __________________________________________________________

Address: ________________________________________________________

Daytime Phone: ___________________      Evening Phone:    _______________ 

Are you currently involved in a Neighborhood Watch group? __________________

If yes, please answer the following questions: 

            Who is your Block Captain?: ___________________________________

                                             Address: ___________________________________

            Approximately how many homes participate in your group?: __________

            Does your Neighborhood Watch group have meetings?: _____________

            What is your group’s area of interest?

            _____ Crime Prevention              _____ Home Security 

           _____ Gangs/Drugs                    _____ Emergency Preparedness    

_____Personal Security               _____Fire Awareness

............Do you receive the Neighborhood Watch Newsletter? _____

            If yes, indicate how you receive the newsletter

            _____ Block Captain’s distribution

            _____ La Mirada Community Sheriff’s Station

            _____ City Hall

            _____ Other (Please Explain) ___________________________________

If not, would you like to receive the newsletter? _____

Are you interested in participating in a future volunteer program? _____

If yes, what types of opportunities would you be interested in? _______________

Please return the completed form to City Hall or the Community Sheriff's Station.. 

For more information on Neighborhood Watch, contact City Hall at (562) 943-0131 or the Public Safety Team at (562) 902-2960.

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