Form Center

2. First Name
3. Last Name
5. Address1
7. Address2
9. City
10. State
11. Zip
13. Email Address
15. Telephone*
16. Alternate Telephone
18. Hold Harmless Clause
    The applicant hereby releases Decatur Fire Department and the City of Decatur of any and all liability pertaining to the performance of the smoke alarm in the event the smoke alarm fails to perform properly during a fire or any other conditions the smoke alarm was designed to operate in. The applicant also agrees to release the Decatur Fire Department and the City of Decatur of any liability pertaining to damage that may result during the installation of the smoke alarm. The applicant will also allow Decatur Fire Department to install the smoke alarm and to inspect and perform any related and necessary maintenance at no charge to the applicant.
20. Agreement to Hold Harmless Clause*

    By checking this box, you agree to the above-stated hold harmless clause.

    1. I agree.
21. 
Leave This Blank:


24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit

* indicates a required field