Community Program Request
Glendale Fire Department
Name of Organization, School or Group
*
Point of Contact
*
First Name
Last Name
Contact Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Location of Event or Program
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Preferred Date:
*
-
Month
-
Day
Year
Requests made with 30-60 days' notice have the greatest chance of being fulfilled.
AZ-MST
AM
PM
AM/PM Option
Duration of Event
Backup Date:
*
-
Month
-
Day
Year
Date
Time (MST) Minutes
AM
PM
AM/PM Option
Number of participants
*
Minimum 8 - Maximum 30
What type of program are you scheduling?
*
Fire & Life Safety
Classroom Visit
Workplace Safety
Guest Speaker
Special Event
Other
Additional Information
Example: Compression-Only CPR, Fall Prevention, Fire Extinguisher
Audience Type
*
Business or Workplace
Preschool
Adults
Elementary (K-2nd)
Seniors
Elementary (3rd-6th)
Youth Serving Organization
Middle School (7th-8th)
Other
High School (9th-12th)
Can your organization provide the ability to show Powerpoint?
Yes
No
Submit
Should be Empty: