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2. 

4. In partnership with the Department of Health, the Pembroke Pines Fire Rescue Department is offering free door alarm installations only to Pembroke Pines residents who have residential pools.

   
   

   Note: this will not be available to Multi-unit Housing Complexes.

6. First Name*
7. Last Name*
9. Address*
11. City*
12. State*
    -- Select One --AKALARAZCACOCTDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVTVAWAWVWIWY*US Territories (AS, DC, FM, GU, MH, MP PW, PR, VI)*Outside US
13. Zip Code*
15. Phone Number (Cell)*
16. Email Address*
18. Home Owner if Different from Above*
20. Number of Levels
21. Indicate type of pool*
    -- Select One --Above GroundIn-ground
23. Size of Pool*
25. Best way to reach you to schedule a timeframe for the day of installation? We will try to accommodate your request.
Leave This Blank:


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

    This field is not part of the form submission.

29. Submit

* indicates a required field