Blank Children's Hospital
1200 Pleasant Street
Des Moines, IA 50309
515.241.KIDS

Fire Safety House Request

If you'd like the Fire Safety House to visit your area, please complete and submit the following form. Check availability of the Fire Safety House by viewing the Calendar. The Fire Safety House program coordinator will contact you within five business days upon receipt of your request to help you plan a successful fire safety event in your area. If you have additional questions, don't hesitate to contact the FSH program coordinator.

Please view and print the Fire Safety House Terms and Conditions for use.

Has the FSH been to your area before? *YesNo If yes, dateOrganization sponsoring the Fire Safety House visit * Contact person(s) * Daytime telephone * Evening telephone * Fax number * Email address * Event address * City * Zip code * County * If sponsoring organization is not a fire department with what fire department will you be partnering for this event?(Partnership with a fire department is not required but is preferred.)Please list any additional sponsorsType of event *Community Event(s)School Visit(s) Type of training *Fire SafetySevere Weather Training Name of school/event * Will you *Stay in the same location for your event?Take the FSH to more than one location? Date * Start time * End time * Projected number of children * Projected number of adults * You may submit your request online by clicking Submit (below).By clicking Submit, you acknowledge that you've read and agree to the Terms and Conditions of Use.How will this event impact/affect the children in your community? *