Jefferson Community College Security Office
To be completed in full and filed with the Campus Security Office -
Name (
print): _____________________ Phone Number: ( ) _____________
Vehicle: _______________________________ Plate: _________________
The vehicle is parked in Parking Lot: ________ and will be parked from:
date) ______________ to (date) ______________.
(It is recommended that unless your vehicle is remaining on campus in its current location due
to a break down that you park your vehicle in the B Lot where it can best be monitored by the
security staff.)
Third party notification – In the event of a problem with your vehicle while left at JCC
(fuel leak, motor vehicle accident, vandalism, etc.) please provide the name and phone number
of an individual who can be contacted to assist with your vehicle if you will be out of the area.
Name: ______________________ Phone: ( ) _________________
It is recommended that you:
Remove all valuables from the vehicle
Remove your keys and lock your vehicle
Neither Jefferson Community College nor any member of the Security Staff will be
responsible for any losses from or damage to your vehicle while left on the campus.
After 96 hours, vehicles left without prior approval are considered abandoned (Section
1224 of the Vehicle and Traffic Law of the State of New York) and are subject to removal.
Signed _____________________________ Date _______________