2. 

4. CITY OF PUEBLO FIRE DEPARTMENT
    EVENT REQUEST FORM

   1551 Bonforte Blvd
   Pueblo, CO 81001
   Phone: (719) 553-2830 pueblo.us/fire

6. The Pueblo Fire Department offers the opportunity for citizens to request life-saving training and public education. Restrictions apply and all requests may not be fulfilled, due to availability of crews on selected days. Please review the checklist before submitting your request.

   ✔ Is your event in the City limits? We are only available for events that take place in Pueblo, CO.
   ✔ Requests are to be scheduled no less than 2 weeks prior to the event.

8. Company Name:
9. Date*
   Date
11. Contact Name:*
13. Address:*
15. City:*
16. State:*
17. Zip:*
19. Phone #1:*
20. Phone #2:
21. Email:
25. LIFE SAFETY TRAINING
27. LIFE SAFETY TRAINING

    1. High Rise Drills
    2. Fire Extinguisher Training

    1. Fire Safety
    2. Fire Prevention

    1. Access to Care
    2. Other
29. if Other, please explain*
31. 
    Requested Dates: Provide 1st Choice:*
    
    Requested Dates: Provide 1st Choice:

    
    Requested Dates: Provide 1st Choice:
32. 
    to*
    
    to
34. 
    Requested Dates: Provide 2nd choice:
    
    Requested Dates: Provide 2nd choice:

    
    Requested Dates: Provide 2nd choice:
35. 
    to
    
    to
39. PUBLIC EDUCATION
41. Public Education

    1. Fire Station Tour
43. 
    Provide 1st date/time choice
    (Station Tours are 30 minutes long)*
    
    Provide 1st date/time choice
    (Station Tours are 30 minutes long)

    
    Provide 1st date/time choice
    (Station Tours are 30 minutes long)
44. 
    to*
    
    to
46. 
    Provide 2nd date/time choice
    
    Provide 2nd date/time choice

    
    Provide 2nd date/time choice
47. 
    to
    
    to
49. How many children
    are attending?*
50. Grades/Ages of Children:*
51. How many
    Adults?*
53. Visit*

    1. School Visit

    1. Community Event

    1. Health Fair

    1. Other
55. If other, please explain *
57. Event Name*
59. Event Address*
61. Event Date*
    Event Date
62. Event Time*
    Event Time
64. Requesting a Fire Truck?*

    1. Yes
    2. No
65. Will a tent/booth and table be provided at the event?*

    1. Yes
    2. No
67. Additional Information you would like to share about your event:
69. Please submit your request – We will review the request and contact you. Thank You!
Leave This Blank:


71. 1. Receive an email copy of this form.
72. Email address

    This field is not part of the form submission.

73. Submit

* indicates a required field