Fire Prevention Visit On-Line Request Form

Please read the following information before submitting your On-Line Request for a Fire Prevention Visit!

The Fire Prevention Department makes no guarantee that the times you have selected will be available. As a rule, the earlier you submit your request, the more likely that we will be able to fulfill it.

Those submitting requests should be aware that no visits will be scheduled for Fire Prevention Week, as it has been set aside exclusively for Elementary school visits and Open Houses at the EFD stations. The time between Sept. 15 and Nov. 15 is extremely busy, so please get your requests in early for those months.

The Fire Prevention Department regrets that it cannot schedule visits outside the boundaries of the City of Eagan. Those living outside the City of Eagan are encouraged to contact their local fire department for scheduling visits. Fire Departments and other organizations outside the City of Eagan may rent the Safety House for special events; please contact us for details.

Certain events may occur that will force a delay to the start of an event or cancel it altogether. Firefighters may also have to cut short a visit in order to respond to an emergency within the City of Eagan. These events include, but are not limited to: Emergency fire or medical response, impending severe weather, or unexpected personnel shortage. These events are rare, and if they interfere with your scheduled visit, we will take steps to reschedule your group with highest priority.

You should receive a confirmatory telephone call from the Fire Prevention Department within 3 business days of sending this form. If after three business days you have not received a response, please feel free to contact us at the Administrative offices of the Eagan Fire Department.

Note to businesses requesting promotional visits:
Under certain circumstances, the Fire Prevention Department will provide vehicle's) and personnel to coincide with your promotional activities, such as Community-oriented events and charitable events. Be aware that Fire Department personnel may take advantage of the event's publicity to recruit new members and/or raise funds for non-budgeted special equipment items. All submissions will be carefully reviewed to determine the suitability for the presence of a Municipal Department at these events. Please submit these requests with a MINIMUM 1 month advance notice.

Your Name:
Representing (if applicable) :
Street Address:
City:
State:
Zip:
Daytime contact phone:
Evening contact phone:
E-Mail Address:
Event Location (Street Address):
Event Location Description (i.e. Pinewood Elementary, etc):
Event City:
What date (mm/dd/yyyy) are you planning for the Fire Prevention Visit? use date separator "/"
What time do you wish the Fire Prevention Visit to begin? use time separator ":"
What type of Event are you planning?	Business visit-Promotional Business visit-In-house Education Neighborhood Watch Scouting Event (Boy Scouts, Girl Scouts, etc.) School or Classroom visit Station 5 Tour Station 4 Tour Station 3 Tour Station 2 Tour Station 1 Tour
What is the age range of the intended audience?	Children and Adults Children, various ages Jr. Hight 9 - 11 yrs 6 - 8 yrs Audit Audience 3 - 5 yrs
How large is the intended audience?	Select audience range over 100 51-100 26-50 21-25 16-20 11-15 6-10 Less than 5
How much time do you wish the visit to take?	Select visit time 3 hour or more 2 hour 30 minutes 2 hour 1 hour 30 minutes 1 hour 45 minutes 30 minutes Less than 30 minutes
Please Check the general subject(s) that you would like covered during this visit:
Fire Prevention General:
Fire Prevention Specialized:
Fire drills and escape:
Neighborhood Watch:
Fire Extinguisher Demonstration:
Health Fair:
CPR First Aid:
Hazardous Materials:
Home Safety Inspection:
The Fire Prevention Department will bring at least one vehicle to your event. No vehicle will be guaranteed; we can only bring that which is available to us that day. If no vehicle is needed (say, for a health fair event), please indicate in the first box. Otherwise, please indicate your choice of vehicles to respond to your event.
First choice:	Rescue Rig Grass Rig Fire Engine/Ladder Truck Safety Trailer (for drill/escape classes)
Second Choice:	Rescue Rig Grass Rig Fire Engine/Ladder Truck Safety Trailer (for drill/escape classes)
Third Choice:	Rescue Rig Grass Rig Safety Trailer (for drill/escape classes) Fire Engine/Ladder Truck
The Fire Prevention Department has a limited supply of items that can be brought to enhance the presentation to different groups.
Fire Hats:
EFD Replica Badges:
Informational Brochures:
Kids misc stuff:
Additional Information for this Fire Prevention Visit Request:
Please check the form for errors.
Verification Code:
Please Enter Verification Code:

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