Coolidge Fire Department Smoke and Co Detector Program

"Get out Alive"

Alarm Request Form

Please complete the following form to request a smoke alarm or carbon monoxide detector through the Coolidge Fire Department's "Get Out Alive" program.

For additional questions, please contact the CFD Fire Station #1 at (520) 723-6019. Please note, all alarms are donated and are reserved for citizens in the City of Coolidge that meet certain criteria. This questionnaire will help us determine if we can assist you.

Contact Information

Phone Number

Alternate Phone Number (optional)

Please, answer ALL of the following questions to help us better serve you. The answers are for CFD use only.

Does this residence currently have a working smoke alarm?

Yes

* Do you own or rent?

Rent

Own

* If you are renting/leasing the residence, your landlord is required by law to provide a working smoke detector.

Are you or any member of the household disabled?

Yes

Are you or any member of the household a senior citizen?

Yes

Number of people living in the home

Age of Homeowner