Muscatine Fire Department Fire/EMS Event Request

Today's Date*

Date of Event*

Start Time:*

End Time:*

Contact Person*

Contact Phone and email*

Location of Event*

Reason for EMS/Fire Standby*

Is Fire/EMS Standby Required for your Event to Function? *

Yes

No

Staffing Requested*

Engine with 3 Ambulance with 2

EMS ATV with 1

Please list if you are a non-profit or governmental agency*

Requesting tour of Fire Station (provide at least three potential dates)

Number of students, staff to tour Fire Station

What grade are the students