Fire Safety Questionairre ( receive a fire blanket)
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Email *
1. Check any of the dangers that you are concerned about. *
Required
2. How long do you have to escape a home fire? *
3. Have you ever had a fire? If yes, please explain. *
4. Do you have children, pets or both living at home? *
5. Married, living together or single? *
6. Your Occupation ( do you have fire drills at work?) *
7. Spouse Occupation
8. Age Range *
9. Do you own or rent *
Cell phone number to be reached at only if selected in the drawing. *
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