Security Camera Disclosure Form | Video Surveillance Notice & Consent | Group Home and Independent Living Template

Clearly communicate your facility’s use of security cameras with this professional Security Camera Disclosure Form & Video Surveillance Notice Template.
Designed for independent living facilities, group homes, transitional housing programs, supportive living programs, and other residential settings, this customizable form provides an organized way to notify residents about video surveillance in designated areas of the property.

Use this form during resident intake, admission, orientation, or onboarding to document that residents have been informed about your facility’s security camera and surveillance practices. The current download includes both PDF and Word formats for convenient printing and customization.

WHAT’S INCLUDED
This Security Camera Disclosure Form includes sections for:
• Facility / Program Information
• Resident Information
• Security Camera Disclosure
• Video Surveillance Notice
• Purpose of Security Cameras
• Common-Area Surveillance
• Camera Location Information
• Private-Area Privacy Expectations
• Recording Disclosure
• Resident Acknowledgment
• Resident Signature
• Staff / Administrator Signature
• Date of Acknowledgment
• Additional Facility Information

PERFECT FOR
• Independent Living Facilities
• Group Homes
• Transitional Housing Programs
• Supportive Living Programs
• Supportive Housing Programs
• Shared Housing Programs
• Adult Residential Programs
• Residential Care Programs
• Housing Program Operators
• Group Home Owners
• Program Directors & Administrators
CREATE A CLEAR VIDEO SURVEILLANCE DISCLOSURE PROCESS
Security cameras may be used by residential programs for safety, security, property protection, and incident review. A written disclosure provides residents with clear information regarding the presence and use of surveillance cameras.
Use this template to help:

✓ Notify residents about security cameras
✓ Identify areas where cameras may be present
✓ Explain the purpose of video surveillance
✓ Communicate privacy expectations
✓ Document resident acknowledgment
✓ Maintain organized disclosure records
✓ Include surveillance information in resident onboarding
✓ Create a consistent disclosure process

DESIGNED FOR RESIDENTIAL PROGRAMS
This Security Camera Disclosure Form can be incorporated into your existing resident admission and onboarding paperwork.
It works well alongside other residential program documents such as:

• Resident Intake Forms
• Program Rules & House Expectations
• Resident Agreements
• Media Release Forms
• Behavior Plans
• Incident Reports
• Resident Acknowledgment Forms

The form is specifically designed around surveillance in common areas while recognizing privacy considerations for private spaces.

CUSTOMIZABLE FOR YOUR FACILITY
Every residential program has different security practices. Customize the document to accurately reflect your organization’s surveillance system and policies.
Personalize information such as:

• Facility name and logo
• Facility address
• Contact information
• Camera locations
• Areas under surveillance
• Purpose of surveillance
• Recording practices
• Access to recordings
• Privacy policies
• Facility-specific procedures

DIGITAL DOWNLOAD
This is a digital product. No physical item will be shipped.
Your purchase includes PDF and Word document formats.

After purchase, download your files, customize the applicable sections for your facility, and print or maintain completed disclosure forms according to your organization’s documentation procedures.

IMPORTANT DISCLAIMER
This template is provided for general administrative and informational purposes only and does not constitute legal, privacy, housing, licensing, regulatory, or compliance advice.
Video and audio surveillance laws vary by state and jurisdiction. Requirements may differ depending on where cameras are located, whether audio is recorded, who has access to recordings, how recordings are stored, and the type of residential program being operated.

Organizations are responsible for determining the surveillance, privacy, consent, and disclosure requirements applicable to their facility and customizing this document accordingly. Consider having your completed surveillance policies and disclosure form reviewed by a qualified legal professional before use.

Due to the nature of digital products, all sales are final.