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Home Safety Assessment Sign Up Form

4. Request a Home Safety Assessment from our Community Risk Reduction Specialist
6. It is essential to maintain smoke and carbon monoxide alarms on every level of your home, create a fire escape plan, and have a basic understanding of potential hazards within your home.
   
   This service is offered to residents of Bayside, Brown Deer, Fox Point, Glendale, River Hills, Shorewood, and Whitefish Bay.

8. Learn more about home safety assessments.

10. First Name*
11. Last Name*
13. Street Address*
15. City*
16. State*
18. Zip Code*
19. Country*
21. Email*
22. Phone*
24. Preferred contact method:

    1. Phone
    2. Email
26. Comments
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28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

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