2. Public Education / Special Event Request

4. Clay Fire Territory offers a number of community services for citizens and students. To request more information, please complete the form below. 

   Please note: We require a minimum of 14 days' notice for all community service requests. 

   Event times cannot exceed two hours.

6. First Name*
7. Last Name*
9. Company Name
11. Address1*
13. City*
14. State*
15. Zip*
17. Phone Number*
18. Email Address*
20. Date of Event*
    Date of Event

    Date of Event
    Please submit 3 options for possible dates.
22. Date of Event (Option #2)
    Date of Event (Option #2)

    Date of Event (Option #2)
24. Date of Event (Option #3)
    Date of Event (Option #3)

    Date of Event (Option #3)
26. Length of Event
28. Which program would you like to request*
    -- Select One --Grade K - Tools and Toys ProgramGrade K - What's Hot and Not ProgramGrade 3 - 911 for kidsGrade 3 - Pillow Case ProjectIntermediate/High School - Career in Fire ServiceFire Station TourCub / Girl Scout TourParade RequestSchool FairFire Truck RequestSafety EventSafety Lecture PresentationOther safety or injury reduction programs (explain in comment area)Library - Preschool - Firefighter read-along program Senior Citizen SafetyEvacuation Training (Group R, A-1, A-3, B,E occupancy)Fire Extinguisher Training (Group R, A-1, A-3, B,E occupancy)Youth Fire Involvement InterventionPoison PreventionEmergency Plan Development & Review for commercial occupancyHome Safety Surveys

    Please select one
30. Clay Fire Member Request
32. Description and Location of Event*
34. Number of Attendees
35. Age Range of Children
37. Comments
39. ADM - 117 (05/2017)
43. Office Use:
Leave This Blank:


54. 1. Receive an email copy of this form.
55. Email address

    This field is not part of the form submission.

56. Submit

* indicates a required field