Skip to content
About
Chief’s Welcome
Meet Our Staff
Mission, Vision & Values
Our Facilties
Our History
Gallery
Fire Commission
Board Of Commissioners
Board Meeting Schedule, Agendas & Archives
Financial Reports Archives
View Live Meeting
General Info
General Announcements & Event Calender
Weather Updates
Public Records Request
Neighboring Fire Departments
Helpful Links
Employment Opportunities
Prevention & Community Outreach
Fire inspection
Fire Safety
Hurricane Safety
CPR Training
Special Event & Speaking requests
In Memoriam
Contact Us
About
Chief’s Welcome
Meet Our Staff
Mission, Vision & Values
Our Facilties
Our History
Gallery
Fire Commission
Board Of Commissioners
Board Meeting Schedule, Agendas & Archives
Financial Reports Archives
View Live Meeting
General Info
General Announcements & Event Calender
Weather Updates
Public Records Request
Neighboring Fire Departments
Helpful Links
Employment Opportunities
Prevention & Community Outreach
Fire inspection
Fire Safety
Hurricane Safety
CPR Training
Special Event & Speaking requests
In Memoriam
Contact Us
About
Chief’s Welcome
Meet Our Staff
Mission, Vision & Values
Our Facilties
Our History
Gallery
Fire Commission
Board Of Commissioners
Board Meeting Schedule, Agendas & Archives
Financial Reports Archives
View Live Meeting
General Info
General Announcements & Event Calender
Weather Updates
Public Records Request
Neighboring Fire Departments
Helpful Links
Employment Opportunities
Prevention & Community Outreach
Fire inspection
Fire Safety
Hurricane Safety
CPR Training
Special Event & Speaking requests
In Memoriam
Contact Us
About
Chief’s Welcome
Meet Our Staff
Mission, Vision & Values
Our Facilties
Our History
Gallery
Fire Commission
Board Of Commissioners
Board Meeting Schedule, Agendas & Archives
Financial Reports Archives
View Live Meeting
General Info
General Announcements & Event Calender
Weather Updates
Public Records Request
Neighboring Fire Departments
Helpful Links
Employment Opportunities
Prevention & Community Outreach
Fire inspection
Fire Safety
Hurricane Safety
CPR Training
Special Event & Speaking requests
In Memoriam
Contact Us
Contact in English
PROJECT: WAKE UP!
Smoke Detector Request Form
You must reside in Collier County and fill out the smoke detector request form completely to be considered for program participation.
Contact in English
Property Owner
Name
Last
First
Middle Initial
Phone
Phone
Address
Street Address
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Ã…land Islands
Country
Occupant at location of install
Name
Last
First
Middle Initial
Phone
Phone
Address
Street Address
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Ã…land Islands
Country
I live in the jurisdiction of the _______ Fire District.
1. Have you had any serious fires in your current home or former homes?
Yes
No
2. Do you have smoke detectors?
(a). Yes
(a). No
Other
(b). Are they currently working?
Yes
No
(c). If they are not, why? Check which No time to get one reasons apply.
Took out the batteries
Batteries do not work Other (please describe)
Other (please describe)
Other
(a). If No, Why not?
Can’t afford one
Didn’t think of it
No time to get one
Cannot install it
Other
3. How many children age 5 or younger live in your home?_________
4. How many occupants including children live in your home?________
5. I live in a (circle one)________ one story two story_______ mobile home _______duplex.
6. What is the approximate square footage?________
II meet set forth eligibility requirements, I will be contacted by the Fire Control District to schedule installation within 30 days. 1 understand this vequest for a smoke detector does not guarantee that assistance will be granted, but will be used in determine el; igibility for the program.
Requestor’s Signature.
Date
MM slash DD slash YYYY
You can turn this request form or mail to the Immokalee Fire Control District; 502 East New Market Rd. Immokalee FL, 34142
Δ
PUBLIC EDUCATION REQUEST FORM
Name
Organization / Affiliation
Address
Street Address
Phone Number
Email
(Required)
Type of Public Education Requested
(Required)
Fire Station tour
School Visit (Stop-Drop-Roll, Fire Drill, show truck & turnout gear, etc.)
Fire Truck and Handouts
Fire Extinguisher Training
Other ( Must fill out special request area)
Special Request / Learning Goal
If Visiting a Fire Station, please select a station
Station 30 (New Market Rd.)
Station 31 (Carson Rd.)
Station 32 (AV Maria)
Or, If any other type of event, Please enter location
Date and time requested
MM slash DD slash YYYY
Time
Hours
:
Minutes
AM
PM
AM/PM
Alternate Date and time 1
MM slash DD slash YYYY
Time
Hours
:
Minutes
AM
PM
AM/PM
Alternate Date and time 2
MM slash DD slash YYYY
Time
Hours
:
Minutes
AM
PM
AM/PM
Number of Kids Age 4-6
Number of Kids Age 6-7
Number of Kids Age 7-9
Number of Kids Age 10-17
Number of Kids Age 18 and Older
Are you a real human?
(Required)
Please show us by solving this equation…
5 + 5 =
Select one
25
5
10
Δ
PUBLIC EDUCATION REQUEST FORM
Name
Organization / Affiliation
Address
Street Address
Phone Number
Email
(Required)
Type of Public Education Requested
(Required)
Fire Station tour
School Visit (Stop-Drop-Roll, Fire Drill, show truck & turnout gear, etc.)
Fire Truck and Handouts
Fire Extinguisher Training
Other ( Must fill out special request area)
Special Request / Learning Goal
If Visiting a Fire Station, please select a station
Station 30 (New Market Rd.)
Station 31 (Carson Rd.)
Station 32 (AV Maria)
Or, If any other type of event, Please enter location
Date and time requested
MM slash DD slash YYYY
Time
Hours
:
Minutes
AM
PM
AM/PM
Alternate Date and time 1
MM slash DD slash YYYY
Time
Hours
:
Minutes
AM
PM
AM/PM
Alternate Date and time 2
MM slash DD slash YYYY
Time
Hours
:
Minutes
AM
PM
AM/PM
Number of Kids Age 4-6
Number of Kids Age 6-7
Number of Kids Age 7-9
Number of Kids Age 10-17
Number of Kids Age 18 and Older
Are you a real human?
(Required)
Please show us by solving this equation…
5 + 5 =
Select one
25
5
10
Δ
