Illinois - Smoke Alarm Request

Home Fire Safety Education Request – Illinois
Please complete the form below to sign up for a FREE Home Fire Safety Education session, to help make your home safer against home fires. A member of our Home Fire Campaign team will follow up with you to schedule a virtual appointment either over the phone or through a virtual conferencing platform.

Please note, this form is for residents of the Illinois Region ONLY. To learn about Red Cross services in other states, please contact your local chapter.
Name:

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County
Type of Dwelling e.g. single family home, townhouse, apartment, etc.
# of Levels, including basement
# of Smoke Alarms in home
Is anyone in the residence deaf or hearing impaired?
Preferred day and time-frame for appointments:
How many people live in your home?
How many youth under 17?
How many adults over 65?
How did you hear about this service?
Should be Empty:

Home Fire Safety Education Request – Illinois