Department Name*
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Contact Person*
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Phone Number*
Please enter a valid phone number including area code. xxx-xxx-xxxx
Mailing Address (including City, State, Zip)*
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Alt. phone number*
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Email*
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Fax Number
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Time*
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Time *
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Time*
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If other
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Have you invited the following?
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Do you have a secure, flat parking area longer than 100 feet?
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Describe your event:*
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Locaton of Event*
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Location Address*
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Phone*
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Backup Location (if different)
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Back up location address
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Backup Location Phone
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I agree that while at the above listed organization's location, all policies for the fire safety house will be followed. In addition, I agree to notify the Fire Marshal's Office of any damages of the fire safety house or any of it's contents. We will follow all applicable laws while using the fire safety house and hold harmless the City of Chattanooga, Department of Public Safety, and the Fire Marshal's Office for any negligence as a result of misconduct or improper use by the user
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Signature (by typing in your name you agree to the above statement)*
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