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CSFD: Prevention & Safety Speaker Request Form

The College Station Fire Department can provide a speaker for fire safety, fall prevention, fire science, escape planning, or other relevant topics. Speaking engagements do not include a visit from a fire engine or other apparatus.

If you are requesting a speaker for a presentation at your facility, there must be a minimum of 10 attendees. If you are requesting a speaker at one of our fire stations (Station 3, 5, or 6), the number of attendees is limited to 50.


Name of Organization:

Name of Event (if applicable):

Contact Name:

Phone Number:

E-Mail Address:

Number of Participants:

Age Range of Participants:

How much time do we have to present?

If you would like to schedule your presentation at a fire station, please select which station you prefer:
If you would like to schedule your presentation at your facility, please give the physical address:

Does your facility have access to (check all that apply):
Is there a particular topic that you would like your group to learn more about?
Please list/describe the topic(s) that you'd like us to cover:

The fire department will make every effort to accommodate your request but cannot guarantee that the times requested will be available.

Please provide three dates and times that you would like to request a speaker.




Please note any additional information that may be helpful when scheduling your request:

I, for myself and my organization, school or group, release and agree to hold harmless for any and all purposes the City, its agents, officers, employees, volunteers and assigns from any and all liabilities, claims, demands, or injuries that may be sustained by me or my organization, school or group members in attendance as a result of or arising from me or my organization, school or group, participating or performing activities for or in the College Station Fire Department.*
I, for myself and my organization, school or group, hereby accept and assume all risk and responsibility for any harm, injury, or damage, to myself or my property, while my organization, school or group and I are on City-owned property or any other property and while participating or performing activities for or in the College Station Fire Department.*
I hereby give the City the right to photograph, televise, film, and sound record me and my organization, school or group acts, appearances and utterances of me and those from my organization, school or group and to use any descriptive words or names, including my name or my organization, school or group name in conjunction therewith and without limit as to the time, to produce and reproduce the same or any part thereof by any method and to use for any purpose which the City deems proper. All such photographs, teletapes, films and sound recording shall be the exclusive property of the City and I and my organization, school or group hereby relinquish all rights, title, and interest therein.*
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