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2. Smoke Alarm Request Form

   
   

   The Trophy Club Fire Department wants to assist our residents with maintaining working smoke alarms in their homes. Smoke alarms are a valuable tool designed to give occupants an early warning of a fire so they will have as much time as possible to exit their home safely.

   The Trophy Club Fire Department offers the installation of battery-operated smoke alarms for our residents. These smoke alarms are often purchased with donated funds from local businesses and civic groups to reach target populations including:

   * Homeowners over 55 years old

   * Homeowners with a disability

   * Homeowners who cannot afford smoke alarms

   For safety and liability purposes, fire department staff are not permitted to:

   * Replace hardwired smoke alarms that require a new adapter to be connected to the home's electrical wiring using wire nuts

   * Service, install, or replace smoke alarms that cannot be safely accessed using a maximum 8-foot step ladder

   We do not install smoke alarms in rental properties, however the State of Texas mandates that the property owner is required to install and maintain smoke alarms and our Fire Marshal’s Office will work with you to ensure your landlord is providing the minimum required fire safety equipment. 

   Please call 682-237-2947 if your landlord has not furnished your rental property with working smoke alarms.

4. First Name*
5. Last Name*
7. Address*
9. Email Address*
11. Phone Number*
13. Type of service requested*
    -- Select One --Provide and install new smoke alarms in my homeInstall new batteries in an existing smoke alarmEvaluate my home to see if I need more smoke alarmsOther (please explain below)
14. Number of smoke alarms/batteries needed*
16. Special notes:
18. For statistical purposes, please check any that apply:

    1. I am a homeowner over the age of 55
    2. I am a homeowner with a disability
    3. I am a homeowner and cannot afford to install smoke alarms
    4. I am a homeowner who is unable to safely install a smoke alarm or change a smoke alarm battery
    5. None apply

20. • By completing and signing this application form, I accept full responsibility for the maintenance of the smoke alarms(s) installed for me by the Trophy Club Fire Department. I acknowledge that the smoke alarm is provided as a courtesy and I release the Town of Trophy Club, its employees, officers and elected officials from all liability related to the smoke alarm, its installation, operation, maintenance and care or lack thereof.

      I acknowledge that there are multiple types of smoke alarms on the market that use different sensors to detect different types of fire at different rates and that the smoke alarms provided to me by the Trophy Club Fire Department may not provide as fast of a response to a fire as other smoke alarms currently available.

      I acknowledge and understand that smoke alarms should be tested monthly and that the battery should be changed on an annual basis. The maintenance, testing and replacement of smoke alarm batteries are my responsibility.

      This release from liability is binding on me, my family, all of my heirs, successors and assigns.

22. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 

    1. Your application will not be signed in the sense of a traditional paper document.
    2. By signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature.
    3. You may still be required to provide a traditional signature at a later date.

    1. I agree.
24. Electronic Signature
Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field