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Help us help you !

A non-profit 501(c)3 org

 

CPR Information
Fire Safety House
Request Home Safety Visit
Fire Extinguisher Training
 
SAMS (members only)

 

EMS Manager
Member Login:
Login:
Password:
We use FIRE Manager for online scheduling

2019 Incident Responses
Month Station 8 Station 28 Total
Jan 981 336 1317
Feb 914 329 1243
Mar 1019 339 1358
Apr 914 350 1264
May 1040 381 1421
Jun 955 329 1284
Jul 1062 393 1455
Aug 1041 368 1409
Sep 948 329 1277
Oct 1010 344 1354
Nov
Dec
Total 9884 3498 13382

Historic Incident Responses
Year Station 8 Station 28 Total
2018 12026 4062 16088
2017 11615 3863 15478
2016 11478 3664 15142
2015 11109 3421 14530
2014 10602 3438 14040
2013 10316 3443 13759
2012 10313 3702 14015
2011 9956 3820 13776
2010 10406 3727 14133
2009 10837 3631 14468

Home Fire Safety Visit Request Form

Please confirm whether you are the resident or you are applying on someone else’s behalf, in which case you will need to enter contact information for yourself and the occupier. All fields marked with an * are required.

Required   Indicates Required Field
Are you the resident?: Yes
No
Resident first name: Required
Resident last name: Required
Home address: Required
:
City: Required
Zip code: Required
Email address:
Is this address Owner-Occupied?: Required Yes
No
Is this address a Tennant-Occupied-Rental-Unit?: Required Yes
No
Is this address home to any pets(cats and dogs)?: Required Yes
No
Phone (day) Area code (###): Required
Phone (day): Required
Age of residence (yrs):
Phone (evening) Area code (###):
Phone (evening):
I prefer you contact me by: Phone
Email
No Preference
Type of home (single family, apt, townhouse etc.): Required
Number of floors in home:
Number of working smoke alarms:
Senior citizen?: Required Yes
No
Children in the home?: Yes
No
Any special needs so we can customize our visit (examples: hearing impaired, low vision):
Do you have at least one working smoke alarm in your home?: Required Yes
No
Have you ever experienced a house fire?: Yes
No
How did you hear about this program?:
If you are filling this out on behalf of someone else, please provide your information:
Contact first name:
Contact last name:
Contact Phone Area code (###):
Contact phone:
Contact phone ext:
Contact email:
Prefered appointment times:
Additional information - please supply us with any additional information you would like us to be aware of:




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Gaithersburg - Washington Grove Volunteer Fire Department
801 Russell Avenue
Gaithersburg, Maryland 20879
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Non-Emergency Dial 311
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