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2. Jackson Hole Fire/EMS
   Station Tour / Firefighter Visit Request
4. Name of Organization*
5. Contact Person*
6. Cell Number*
8. Reason for Request*
10. Number and Age of Students*
    Children must be 3 years or older
11. Preferred Dates*
13. The below items must be reviewed and acknowledge by all participants
15. Did you read the firehouse rules?*

    Quiet voices must always be used so we can hear our pagers. Only touch things the firefighters say you can touch, there are a lot of sharp and dangerous tools in the fire station/trucks.

    1. Yes
17. Did you talk to your children about what firefighters do?*

    Fight structure and wildfires. Respond to car accidents. Provide medical care with the ambulance. Check for toxic environments like carbon monoxide. Make safety determinations for public buildings.

    1. Yes
19. Do you know what number to call in an emergency?*

    911. If you are too young to have a phone, learn this number and ask a grown-up to call it.

    1. Yes
21. Do you know what an emergency is?

    Explain why we do not call 911 for things that can be handled by our parents or teachers

    1. Yes
23. Did you have a fire drill this year? Did you explain why?*

    Talk about "getting out and staying out" when we hear a smoke alarm. Go low under smoke, move quickly. Discuss why you are all going out to the same "meeting place"

    1. Yes
25. Do you know your physical address and phone number?*

    When you call 911 this is very important information. We cannot help you, if we cannot find you.

    1. Yes
27. Safety Messages*

    Please visit www.sparky.org. Review activities, videos and firetrucks.

    1. Yes
29. Firefighter Bunker Gear*

    Firefighters will wear bunker gear during the presentation. This includes helmets, masks, air tank etc. Firefighter are there to help you in an emergency situation. If you feel students may be afraid, discuss this with them in advance.

    1. Yes
31. 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.

    1. I agree.
33. Electronic Signature
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35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

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