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Smoke Alarm Request Form
After submitting this form, we will call to set up installation within a few business days.
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* Indicates required question
McHenry Township Fire Protection District
Date
*
MM
/
DD
/
YYYY
Number of Smoke Alarms requested?
*
Choose
1
2
3
4
5
More than 5
Name of person requesting smoke alarms:
*
Your answer
Installation Address
*
Your answer
Phone number with area code
*
Your answer
Email address
Your answer
Number of people living in the home
*
Your answer
Number of people under age 5
*
Your answer
Number of people over age 65
*
Your answer
Number of people with disability/functional needs
*
Your answer
Best days for install:
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Required
Type of Residence:
*
Single Family
Condominium
Duplex (2 Family)
Manufactured (Mobile)
Locations of Existing Detectors
*
Your answer
Submit
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