2. Do NOT Sign In or Create an Account

   You do NOT need to create an account or sign in to complete this form. For the majority of our users, it's best not to create an account or sign in. 

4. Enter the Drawing *

   How would you like to complete the home safety checklist and enter the drawing? If you choose to download and complete the checklist, and your name is drawn for the free lunch prize, we will ask you to share your completed checklist prior to receiving your prize.

   To be eligible for the drawing, you must be a resident or property owner within North Metro Fire Rescue District's coverage area. 

   1. I have completed the downloaded PDF of the checklist. Please enter me in the drawing.
   2. I will fill out the online checklist (Click on the submit button to be redirected to the online form).
6. Name
7. Email Address
9. Address
11. City
12. State
13. Zip Code
15. Phone Number
16. Preferred Contact Method

    1. Email
    2. Phone

    1. Either
18. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) you have completed the home safety checklist, 2) you would like to be entered in the quarterly drawing to have a free lunch delivered to you by North Metro Fire firefighters/staff, 3) you give North Metro Fire the right to contact you and coordinate the delivery of lunch, and 4) in the event there is an issue with the food, which will be prepared by a local restaurant, you will not hold North Metro Fire responsible and will address any issues directly with the food vendor. 

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


22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit Submit and Print

* indicates a required field