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2. Would you like to be able to better serve your community?
   • Become CPR (cardiopulmonary resuscitation) certified
   • Become certified in first aid
   • Become certified with an AED (automated external defibrillator)
   • Become certified in stop the bleed
   • Obtain fire extinguisher training (residential and commercial)
   • Learn about establishing and utilizing and fire escape plan (residential and commercial)

   Do you know you or your family or someone you know need a smoke alarm in their home?

   Barrow County Emergency Services can help!

   We at Barrow County Fire Department want to make sure that our community is as safe as possible! Contact us today; we would love to come out and help install already purchased smoke alarms! If needed, we can even provide and install the smoke alarm for those who qualify!

   For any questions or to schedule any of the services listed above please complete the following form.

   
   

4. Requester's First and Last Name*
6. Requester's Phone Number*
7. Requester's Email Address
9. Requesting Location - Street Address*
11. Street Address Line 2
13. City*
14. State*
15. ZIP Code*
17. Desired Date and Time*
    Desired Date and Time

    Desired Date and Time

    Please indicate the desired date and time in which you would like your event.

19. Estimated Number of Attendees
21. Age Range of Attendees
23. What services can we provide for you?*

    1. AED Training
    2. CPR Training
    3. First-Aid Training
    4. Stop the Bleed Training
    5. Fire extinguisher training
    6. Home or business escape plans
    7. Carbon monoxide alarm installation
    8. Install smoke alarm(s)
    9. Hardwired Smoke Alarm?
    10. Battery Powered Smoke Alarm?
    11. Public Relations / Community Event
    12. Touch A Truck/ Friendly Firefighter
    13. School Visit
    14. Career Day
    15. Fire Safety Talk
    16. Request the Fire Safety House
    17. Other
25. If you selected above to receive a smoke or carbon monoxide alarm, please answer the following.
27. Cooking or heating with gas?

    1. Yes
    2. No
28. Do you rent or own your home?

    1. Rent
    2. Own
30. If renting, please complete the following information.
32. Property Owner's Full Name (first and last)
34. Property Owner's Email
35. Property Owner's Phone Number
Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit

* indicates a required field