Sound the Alarm - NYC Appointment Request / Activa tu Alarma - NYC Solicitud de cita
Dear Resident, Please use this form to sign up for free Smoke Alarms installed by the Home Fire Campaign / American Red Cross in partnership with FDNY and FDNY Foundation. (Please sign up only once) 
Sign in to Google to save your progress. Learn more
First Name  / Nombre *
Last Name / Apellido *
Cell Phone Number / Teléfono Celular *
Please enter only numbers e.g. 9291234567, no spaces, - , ( ) / Ingrese solo números, no espacios, - ,( )
Email /Correo Electrónico
Time of appointment
Please select one or more times you are available
Street Address / Dirección *
e.g. 520 West 49th Street  NOTE: At this time, we do not serve residents in New York City Housing Authority  (NYCHA) building.
Apartment / Apartamento
e.g. 4, 4R, A
Borough / City *
Zip Code / Número Postal *
Note: Is this a NYCHA building? (At this time, we do not serve residents in New York City Housing Authority  (NYCHA) building.)
Where did you hear about this campaign? / ¿Dónde se enteró de esta campaña? *
Notes / Notas : i.e. Are you deaf or hard of hearing and need a Bedside Shaker or Strobe Alarm?/¿Necesita una alarma especial?"
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy