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2. Fire Prevention Education Event Request
4. You will be contacted to confirm the event once approved. Please submit requests at least 30 days prior to the event.
6. First Name*
7. Last Name*
9. Address*
11. City*
12. State*
13. Zip*
15. Phone Number*
16. Date of Request*
    Date of Request

    Date of Request
18. E-Mail Address
19. Preferred Method of Contact*
    -- Select One --PhoneE-Mail
23. Name of Organization*
25. Type of Organization:*

    1. School/Educational
    2. Civic Organization (Scouts, teams, etc.)
    3. Religious Organization
    4. Other/Individual
27. Number of Children Participants*
28. Age Range of Children Participants*
29. Number of Adult Participants*
33. Requested Date and Time for Event*
    Requested Date and Time for Event

    Requested Date and Time for Event
34. Alternate Date and Time for Event*
    Alternate Date and Time for Event

    Alternate Date and Time for Event
36. Requested Location for Event:*

    1. Fire Station 1 (301 W. Main St. Carrboro, NC 27510)
    2. Fire Station 2 (1411 Homestead Rd. Chapel Hill, NC 27516)
    3. Offsite Location (School, preschool, etc.)
38. Address of Event (If offsite location selected):
40. City
41. State
42. Zip
44. Additional Comments/Information

46. This form is for requests for fire prevention education events. Requests are not received 24/7/365. Request submission does not guarantee the department will be able to provide the requested service at the date and time requested. A representative from the fire department will contact you to confirm the request. Please contact (919) 918-7347 if additional assistance is required. 

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48. 1. Receive an email copy of this form.
49. Email address

    This field is not part of the form submission.

50. Submit

* indicates a required field