Fire and Life Safety Activity Request Form - Fire Prevention Bureau

This form should be used to request public education events. This includes requests for fire apparatus and personnel coming on-site at your location as well as requests for station visits and tours. This form should also be used for civic group educational appearances and lectures.

Date of Request Form Submit: *

Requesting Parties Information and Contacts

Group/Organization/Affiliation:

Primary Contact for Event: *

Primary Contact Phone Number: *

Primary Contact Alternate Phone Number:

Primary Contact Email: *

Alternate Contact for Event:

Alternate Contact Phone Number:

Alternate Contact Email:

Address of Group/Organization/Affiliation *

Street Address: *

Street Address Line 2:

City: *

State / Province / Region: *

Postal / Zip Code: *

Event Information

Please provide information specific to the event(s) in this request below.

Date of Event: *

Start Time for Event: *

Multiple Dates: Multiple Date Event If selected, we will contact you to collect the other date(s) and start time(s) for your event.

Type of Event Requested: * Fire Truck Visit at YOUR Location
Fire Station Tour (See Below) *
Fire and Life Safety Presentation
Senior Citizens Fire and Life Safety Presentation
Appearance at Health Fair or Community Safety Event
Job Fair
Home Fire Safety Check

* Please select from the menu below if you are requesting a Station Tour/Visit and know the station you would like to visit. If unknown or you need assistance with determining the best location, please select "Contact Me":

Is the location of the event the same as the mailing address provided above? If no, please provide the location of the event in the fields below: *

Yes No

Address of Event

Street Address: *

Street Address Line 2:

City: *

State / Province / Region: *

Postal / Zip Code: *

If desired, specify topics you would like to be covered: Maximum of 300 characters. Currently Used: characters.

Estimated Number of Adults: *

Estimated Number of Children (17 yrs or younger): *

If applicable, Select Age Range(s) of Children: Pre-K (Ages 2 - 4)
Kindergarten (Ages 4 - 5 )
First Grade (Ages 6 - 7)
Second Grade (Ages 7 - 8)
Third Grade (Ages 8 - 9)
Fourth Grade (Ages 9 - 10)
Fifth Grade (Ages 10 - 11)
Intermediate or Middle School (11 - 13)
Teen (13 - 17)

Comments or Additional Information: Maximum of 300 characters. Currently Used: characters.