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In Case of Emergency, Dial 911
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Company 1 – Jericho Tpke
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Company 4 – Kings Park Road
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Event Request Form
Name of Organization
Date Requested
Contact Name
First
Last
Contact Phone
Secondary Phone
Email
Event Type
Fire Department Tour
School Event
Other (Specify Below)
Other Event Type
Event Date
Event Time
:
HH
MM
AM
PM
Alternative Dates / Times
Number of Participants
Age Group of Participants
0-5
6-12
13-18
Seniors
Desired Topics to be Discussed
Fire Prevention (how to prevent fires)
Fire Safety (what to do during a fire)
CFD Operations (role of a firefighter)
Other (Please specify below)
Other Topics
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