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Fire Safety Education Request Form

  1. Contact Information
  2. Event Information

    (The event must be inside Greene County.)

  3. Type of Event*
  4. I understand that the Fire Rescue Personnel that will be attending the event are on duty and may at any time need to leave for an emergency call.
  5. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  6. Leave This Blank:

  7. This field is not part of the form submission.