Request for Public Education Service - Fire Department

Take Our Posttest and Pretest

This online form will allow you to send your request to the Senior Community Educator for review and scheduling.

Please fill out all required information; this helps us effectively serve your needs. Once requests are received, the information provided is verified with a particular Engine and/or Truck Company’s availability.

Due to our firefighters working on a rotating schedule, we would like a 10-day notice prior to your event.

An e-mail confirmation will be sent to you once your request is received and being processed.

Please allow 2-3 days for us to confirm the event with you. If you have any questions, please contact Jazmine Kilpatrick at (336)773-7965 or jazminek@cityofws.org.

** All information is required

		Your name
		Contact phone number xxx-xxx-xxxx
		Your e-mail
		Organization
		Please select Type of event
		Day of the week
		Date of the event xx/xx/xxxx
		Physical street address
		Start time (include am or pm)
		End time
		Age group
		How many people
Please select an option
Truck/Equipment/Fire Safety Information
Supervision of a Fire Drill Evacuation
Fire Extinguisher Training
Bull-Ex System (live system used for fire extinguisher training)
Career Fair (booth setup)
Station Tour
Blood Pressure Checks
Sparky (Recommended for ages 3-6)
Additional comments or information