City of Victoria Form Center

2. Education Request

   Thank you for your interest in special event education from Victoria Fire Depart. This form must be completed at least fifteen (15) days prior to the event. 

   *Please note some safety precautions may need to be taken (i.e. activities done outside). 

4. Event Information
6. Resource Type Requested: *

   1. Truck Show (Ambulance and/or Fire Truck)
   2. Station Tour
   3. Fire Extinguisher Training
   4. Stop the Bleed
   5. Safe Neighborhood Victoria
   6. Civilian Responder Program
   7. Other

   Select One
8. Event Date: *
   Event Date:
10. Event Time: *

    1. 10:00 AM - 11:00 AM
    2. 11:00 AM - 12:00 PM
    3. 12:00 PM - 1:00 PM
    4. 1:00 PM - 2:00 PM
    5. 2:00 PM - 3:00 PM
    6. 3:00 PM - 4:00 PM
    7. 4:00 PM - 5:00 PM
    8. 5:00 PM - 6:00 PM
12. Event Location (Address) *
14. City*
15. State
16. Zip Code*
18. Estimated Attendance:*
20. Age Range: *
22. What specific location on the property should our resources be placed?
24. For Station Tours, Preference of Fire Station (Location):

    1. Station 1 (606 E. Goodwin)
    2. Station 2 (2708 Miori Lane)
    3. Station 3 (4406 Lone Tree Rd)

    1. Station 4 (2007 Salem Rd)
    2. Station 5 (9508 Zac Lentz Pkwy)
    3. Station 6 (1101 Ball Airport Rd)
26. Contact Information
28. Company/ Group Name: *
30. First Name*
    Responsible Individual
31. Last Name*
33. Address*
35. City*
36. State
37. Zip Code*
39. Phone Number*
41. Email Address*
43. Any additional information you would like to provide regarding this event:
45. Victoria Fire Department will determine whether education request will be offered, and if so, will determine which resources will be used.
    If education request is approved, you will be given confirmation. Factors used to determine whether education request will be offered may include: event attendance, EMS access to venue (area traffic impedance), FIRE/ EMS availability and event impact on 9-1-1 operations.
Leave This Blank:


47. 1. Receive an email copy of this form.
48. Email address

    This field is not part of the form submission.

49. Submit

* indicates a required field