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2. Name (First & Last)
3. Email Address
5. Business Name, if Applicable
6. Address
8. City
9. State
10. Zip Code
12. Primary Phone Number
13. Alternate Phone Number
14. Number of Cameras
15. How long is video stored?
17. Do you record video?
    -- Select One --YesNo
18. Can you export video?
    -- Select One --YesNo
19. Camera Views:
    May select more than one option.
21. 1

    1. Front Yard
22. 2

    1. Rear Yard
23. 3

    1. Driveway
24. 4

    1. Front Door
26. 5

    1. Back Door
27. 6

    1. Patio
28. 7

    1. Parking Lot
29. 8

    1. Lobby
31. 9

    1. Hallway
32. 10

    1. Room/Office
33. 11

    1. Alley
34. Other:
36. Terms of Use:
    If you choose to participate in the program, a crime(s) occurs in your area, and investigators believe your video surveillance may be helpful for investigation of the crime(s), the Lake Saint Louis Police Department will contact you directly, using the information provided by you at the time of registration, to request the appropriate video surveillance footage. Any and all video surveillance footage shall remain the property of the registrant until it is requested by and collected from the registrant by the Lake Saint Louis Police Department. Your voluntary participation in this program shall not be construed as an obligation to release any surveillance video to the Lake Saint Louis Police Department. Any footage containing or related to criminal activity collected by the Lake Saint Louis Police Department may be used as evidence during any stage of a criminal proceeding. Under no circumstances shall registrants construe that they are acting as an agent and/or employee of the City of Lake Saint Louis and/or the Lake Saint Louis Police Department through the program. Under no circumstances shall the Lake Saint Louis Police Department utilize any information obtained to view footage/feeds directly from cameras owned by registrants. The information you provide regarding your video surveillance system will be for official use only, but may be subject to Open Records requests as required by law.
Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

* indicates a required field