4. Public education and public relations requests must be submitted at least 30 days in advance, but no more than 90 days. The form must be filled out completely. We make every effort to fill as many public education/relation requests as possible, but cannot guarantee availability or approval.

   Please limit your request to no more than 3 hours.

   As our emergency call volumes continue to rise, we may not be able to attend your event. We may have to leave unexpectedly due to an emergency incident. If that occurs, we hope you understand and thank you for your continued support.

   We are unable to accept requests for birthday parties, parades and/or grand openings.

6. Group/Affiliation*
8. Contact Person*
9. Title*
11. Email*
12. Contact Person Cell Phone No. *

    In case we need to contact someone before or during the event.

14. Event Title*
15. Event Date*
    Event Date

    Event Date
17. Event Location (include address)*
19. Purpose of Event*
21. Projected number of participants?*
23. Age of Participants*
25. Requested Participation Times:
27. Start Time*
28. End Time*
30. Before making a selection below, please carefully review the days & times offered.
32. Programs are only offered Monday-Friday 9am-4pm.

    If you have any questions, please contact Stacey at 772.621.3375 or Brenda at 772.621.3333.

    1. Fire Safety Presentation with Engine (Schools & Youth Organizations)
    2. Safety House (Schools)
    3. Dusty Dragon, the Spectacular Smoke Smeller
    4. Fire Station Tour
    5. Steps to Safety: Fire and Fall Prevention (Adults 65+)
    6. Fire Extinguisher Training ($10 per person)
    7. Family & Friends CPR (10 Min / 20 Max)(Businesses / HOAs)
    8. Yellow Dot / Medical Information Presentation
34. Programs are offered per availability.

    Your request will be considered per availability, but please remember that actual arrival and duration time cannot be guaranteed.

    1. Fire Engine / Rescue Truck Demo (Touch-a-Truck)
    2. Other (Please explain below)
36. If "other", please leave a detailed explanation:
38. Additional Information Pertinent to Your event:
Leave This Blank:


40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

42. Submit

* indicates a required field