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2. The City of Vandalia Division of Fire is constantly evaluating ways to provide the most current and useful fire safety and injury prevention messages to our community. One of the most efficient and effective tools we have to educate the public is the ability to go out into the public and provide that message. Please use this form to become familiar with the programs we offer and to make a request for the program that best fits your event or need.

   *Please note that the request must be made 2 weeks prior to the event in order to maintain a successful program. If you have any questions you can contact Fire Prevention at 898-2261.

4. Event Contact Person*
6. Phone Number*
8. Email Address*
12. Event Details

    A description of the section goes here.

14. Event Details (Provide a brief description and purpose of your event)
16. Date*
    Date

    *Please consider the two week notice for all events. Call 898-2261 with any questions.

18. Time*
    Time Start Time

    —

    Time End Time

    Start Time - End Time

    Please enter the time you would us at your event to setup (if there is setup time needed)

20. Address*

    Street Address

22. Address Line 2*
24. City*
25. State*
26. Zip Code*
30. Event Options

    Please choose one of the following event types listed below.

    If you have a special request not listed here, please contact 898-2261 with any questions.
32. Select a Choice*

    CPR Classes are conducted through AHA and the standard maximum class size is 30 people unless special provisions are requested, minimum class size is 5. The cost for the basic CPR/AED is $25 for Vandalia residents and businesses and $50 to non-residents and businesses. We also offer practical skills checks free of cost to residents and $25 to non-residents. First Aid Courses and Specialized Courses may be an additional cost. Please call 898-2261 if you have questions.

    1. Fire Engine/Ladder/Medic (Static Display)
    2. Fire Safety in the Work Place (Fire Extinguisher and Fire Safety Training)
    3. Sparky the Fire Dog (Character Interaction)
    4. Home Alone/Baby Sitter Programs (ask for details)
    5. Senior Citizen (Fall and Fire Prevention NFPA)
    6. Bike Helmets/Bike Rodeo
    7. Fire Station Tour (Schools, Scouts, Civic Groups)
    8. Fire Safety Booth (Health Fair, Public Events)
    9. Youth Fire Setting (Special Program, ask for details)
    10. CPR/AED/BLS/First Aid
    11. Other - Please describe your request in the box below
34. Number of Participants:*

    Pleas indicate the number of people that will be in attendance.

36. Indoor, Outdoor or Both?*

    1. Indoors
    2. Outdoors
    3. Both
    4. We are outdoors but have bad weather backup plan
38. For Presentation Events*

    (Please list available A/V Equipment) 

    1. We have full A/V Equipment, all you need to bring is your thumb drive or DVD
    2. We have NO A/V Equipment
    3. We have a projector and screen, you will need a Laptop and connectors
    4. We have a DVD Player
    5. We have a large conference or indoor training room
    6. Other (see details on comments)
40. Please use this space for any questions, comments or special requests.
Leave This Blank:


42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit

* indicates a required field