Safety Education Program Request

Safety Education Program Request

Polk County Fire Rescue believes in public safety education as the key to prevention. Use this form to request a safety education event for your school, business or community group. PCFR makes every effort to accommodate all requests. On occasion elements such as volume of requests, scheduled training, and emergency calls may cause certain requests to be rescheduled, canceled, or delayed. Thank you for your time and interest in the Polk County Fire Rescue Public Safety Education program.

Before requesting a program please be advised:

Priority is given to educational organizations like schools, daycare centers, and community/non-profit groups providing a service or event that promotes fire and life safety.
Fire department personnel and apparatuses do not make appearances at private parties or for-profit functions (e.g. grand opening event for a new business, birthday parties, etc.)

Please provide as much information as possible about your event. Required fields noted in red. Please request services ten to 14 days in advance.

Contact Information

First Name:

Last Name:

Job Title:

Daytime Phone:

Secondary Phone:

Email:

Event Date and Time

First choice:

1) Start Date:

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1) End Date:

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1) Start Time:

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1) End Time:

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Second choice:

2) Start Date:

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2) End Date:

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2) Start Time:

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2) End Time:

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Third choice:

3) Start Date:

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3) End Date:

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3) Start Time:

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3) End Time:

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Event Information

Expected Attendance:

Approx. Audience Age:

Location:

Physical Street Address:

City:

State:

Zip:

Gate code or entry instructions:

Program Request

Fire Engine Visit

Ambulance Visit

Station Tour

9-1-1 (Adults/Children)

Fire Safety (Adults/Children)

Falls & Fires Prevention (Sr. Adults)

Check, Call, Compress (Hands only CPR)

Safety Smart In the Water (Children k-4)

Hurricane Preparedness (Adults/Children)

Pillowcase Project (3-5 Grade)

Other (Describe below)

Please provide a brief description of the event and the type of presentation requesting (hurricane, fire safety, 911, falls etc.).

Description:

Attach any flyers about the event. * File type must be .doc, .docx, .jpg, .png, .gif or .pdf.

Note: If you are requesting a fire engine and/or ems to visit your event, please understand they are available for emergency calls & might have to respond or delay their time at the event. They will also need to be located in an area that allows for easy entrance and exit.

Comments:

A public education officer may contact you for additional information.

Request does NOT guarantee deployment or coverage.

Polk County Seal

The Polk County Board of County Commissioners is an equal opportunity and affirmative action employer.

Polk County Board of County Commissioners

330 W. Church St.
PO Box 9005
Bartow, FL 33831-9005
(863) 534-6000

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