Voluntary Video Surveillance

There is no fee to register, and your information will be kept confidential. You can unsubscribe from the program at any time.  If you wish to update or delete your information, please contact Cpl. Jeffery Samalonis via email or at (609) 654-7511 extension 669. We ask that if you have more than one location you would like to register please submit separate forms for each location. 

Date *
Name/Business Name *
Name/Business Name
Address *
Describe areas recorded. *
Person to Contact *
Person to Contact
Contact Phone Number *
Contact Phone Number
Contact Phone Number #2
Contact Phone Number #2

Printable Registration Form

Should you wish to complete a printable registration form, please utilize the link below. On the registration form, you’ll be asked to provide contact information as well as basic information about the location and recording of your cameras.  There are drop down boxes for some of the blocks where you have to click on the arrow to the right of the box.  You may click on multiple boxes for the areas recorded, and you may provide any additional information in the box provided. Return the completed form by fax to (609) 654-5996 or by email to info@medfordpolice.org.