FireSmart™ Home Ignition Zone Assessment Request Form

FireSmart™ Home Ignition Zone Assessment Request Form

Assessment are done at no Cost to you and is your first step to making your home FireSmart™.
Full Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Are you looking for a Farm and Ranch Assessment?*

YesNo
Preferred way to contact you?*

PhoneEmail
Preferred time of day to contact you?

9am - 11am1pm-4pm4pm-7pmAnytime between (9-4)
Address*

Street Address

Street Address Line 2

CityProvince

Postal / Zip Code
Do you know your fire protection area?
To find your fire protection area click here:

Responding Fire Department.
Would you like information on how to become a FireSmart Collective as well as Neighbourhood Emergency Preparedness?*

YesNo
Would you like our Plant and Landscape specialist to attend during your home assessment?*

YesNo
Would you like our Plant and Landscape specialist to contact you after your home assessment?

YesNo
The personal information collected on this ‘Free Home Assessment Request Form’ is collected under the authority of the Freedom of Information and Protection of Privacy Act (FIPPA) and Comox Valley Regional District (CVRD) bylaws. For questions about the collection of personal information, please contact the Privacy Office at privacy@comoxvalleyrd.ca or at 250-334-6070.
FireSmart, Intelli-feu and other associated Marks are trademarks of the Canadian
Interagency Forest Fire Centre.
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