Safe Home Program Application
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Resident Information
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Address
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Street Address
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Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Are you 60 years or older?
*
Please Select
Yes
No
Are you a Resident of Egelston Township?
*
Please Select
Yes
No
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Home Information
Number of floors (Including Basement)?
*
Please Select
1
2
3
4
Number of Bedrooms
*
Please Select
1
2
3
4
5
6
Do you have a Basement?
Please Select
Yes
No
Do you Own or Rent
*
Please Select
Own
Rent
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You are 60+ years old, Please answer the following questions.
These options are FREE to Residents 60 years and older
Do you need/want Smoke Alarms?
*
Please Select
Yes
No
I am Not 60+ Years old
Smoke Alarms are imperative to Homeowner safety. They are proven to saves lives if a fire were ever to break out in your home. These are installed by the Fire Department.
Do you need/want a Carbon Monoxide Alarm?
*
Please Select
Yes
No
I am Not 60+ years old
Carbon Monoxide Alarms are imperative to Homeowner safety. They are proven to saves lives if CO were ever present in your home. These are installed by the Fire Department.
Do you need/want a Lock Box?
*
Please Select
Yes
No
I am Not 60+ years old
Lockboxes are placed on the outside of your home by the Fire Department with a key supplied by the resident. Only the Fire Department will have access to that key during an Emergency.
Do you need/want a Address sign?
*
Please Select
Yes
No
I am not 60+ years old
Green reflective Address Signs are easier to see and save time when Responders are called to an Emergency situation. Address signs will be installed by the fire department on a supplied post or on your current mailbox post at the discretion of the Fire Department.
Do you have an EXISTING green Address sign?
*
Please Select
Yes
No
I don't know
Green reflective Address Signs are easier to see and save time when Responders are called to an Emergency situation. Address signs will be installed by the fire department on a supplied post or on your current mailbox post at the discretion of the Fire Department.
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You are less than 60 years old, Please answer the following questions.
Do you need/want Smoke Alarms?
*
Please Select
Yes
No
Smoke Alarms are imperative to Homeowner safety. They are proven to saves lives if a fire were ever to break out in your home. These are installed by the Fire Department.
Do you need/want a Carbon Monoxide Alarm?
*
Please Select
Yes
No
Carbon Monoxide Alarms are imperative to Homeowner safety. They are proven to saves lives if CO were ever present in your home. These are installed by the Fire Department.
Do you need/want a Address sign?
*
Please Select
Yes, I have paid or will pay $17 to the Township prior to my install date.
No
Green reflective Address Signs are easier to see and save time when Responders are called to an Emergency situation. Address signs will be installed by the fire department on a supplied post or on your current mailbox post at the discretion of the Fire Department. The cost is $17 to be paid at the Township Hall prior to your install date.
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Appointment Calendar
Please select the best Day and Time. Keep in mind that Emergency's will take priority over your Appointment. If for any reason there is a conflict with the scheduled appointment, you will be contacted by the Fire Department.
Appointment
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