SMOKE ALARM REQUEST FORM

Please complete the following form to request a smoke alarm through the Houston Fire Department's "Get Alarmed Houston" Program.

For additional questions, please contact the HFD Public Affairs Division at 832-394-6633. Please note, smoke alarms are donated and there for reserved for citizens in the City of Houston Limits that meet certain criteria. This questionnaire will help us determine if we can assist you.

CONTACT INFORMATON
Name
Address
Zip Code
Phone Number
Alt. Phone Number

Please, answer ALL of the following questions to help us better serve you. The answers are for HFD use only.
Does this residence currently have a working smoke alarm?	Yes	No
Do you Rent or Own?	Rent	Own
Disabled?	Yes	No
Low-income	Yes	No
Senior Citizen	Yes	No
Number of people living in this residence?
Age of Homeowner?

If you are renting your residence, your landlord is required by law to
provide a working smoke alarm.