Public Education Request Form

2. Preferred Date*
   Preferred Date

   Preferred Date

3. Alternate Date*
   Alternate Date

   Alternate Date

5. Name*

   First and Last Name

6. Phone Number*

   Format (xxx-xxx-xxxx)

7. Email Address*

9. Organization

11. Public Education Progams*
    -- Select One --Community EventDisplay Apparatus & EquipmentK-9 RequestStation Tour (please select station below)ParadeOther (If selected please explain)

12. Choose a Station to Tour
    -- Select One --Eastport Fire Station (Fire Engine, Ladder Truck, Paramedic, and Fireboat)Forest Drive (Fire Engine, Paramedic, Bomb Truck, and K-9)Taylor Avenue Fire Station (Fire Engine, Ladder Truck, Rescue Squad, and Paramedic)

    If you selected station tour in the Public Education Programs menu please select

14. Location of Your Event*

15. Number of Persons Attending (Approx)*

17. Event Description*

    Please describe event

19. Annapolis Fire Department Fire Station Visitation Guidelines
    The chaperone/child ratio shall be at least Pre K, K, ECI - One chaperone to every four children (4-6 y/o) Elementary School – One chaperone to every five children (6-10 y/o) Middle School – One chaperone to every ten students (10-13 y/o) Use the following guidelines to help ensure an enjoyable visit to our stations 1. Always be aware of your children’s location. 2. Be sure to count your children before leaving for an activity, while the activity is underway, before returning from an activity, and upon arrival back from an activity. 3. Remind children of appropriate behavior and group rules. 4. Help children keep track of their personal belongings during the visit. 5. Be aware of the physical condition of your children. If a medical or health problem becomes apparent, notify the on duty personnel immediately 6. Immediately report any major problems to the on duty personnel

    The chaperone/child ratio shall be at least Pre K, K, ECI - One chaperone to every four children (4-6 y/o) Elementary School – One chaperone to every five children (6-10 y/o) Middle School – One chaperone to every ten students (10-13 y/o) Use the following guidelines to help ensure an enjoyable visit to our stations 1. Always be aware of your children’s location. 2. Be sure to count your children before leaving for an activity, while the activity is underway, before returning from an activity, and upon arrival back from an activity. 3. Remind children of appropriate behavior and group rules. 4. Help children keep track of their personal belongings during the visit. 5. Be aware of the physical condition of your children. If a medical or health problem becomes apparent, notify the on duty personnel immediately 6. Immediately report any major problems to the on duty personnel

21. Have you read and understood the Annapolis Fire Department Fire station visitation guidelines*

    1. Yes
Leave This Blank:


23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit

* indicates a required field