CONFIDENTIAL JUVENILE FIRESETTING CONTACT FORM

The Pembroke Fire Department understands that getting young children to be able to distinguish between good fires (fireplace, woodstove, candles, campfires) and bad fires can be a challenge. If you believe that your child is demonstrating an unnatural interest in fire, please contact us so that we can help. The days of dragging a child to the fire station or police station when they were caught playing with fire are no longer satisfactory approaches that result in real success. Our juvenile team have received countless hours of specific training in this subject and are available to help you.

Please use the form below to request a contact from our Juvenile Officer. This form remains confidential and will only be seen by our Juvenile Officer or his superior.

First Name *

Enter your first name

Last Name *

Enter your last name

Age of child *

Enter the age of the child.

Gender of the child *

Enter the child's gender

Family structure *

Select one of the choices that best matches your family structure?

Other Family Structure

If other, please add family structure here.

Siblings? *

How many siblings does this child have? Enter '0' if none.

Description of Behavior *

Provide a brief description of the behavior of the child as it relates to firesetting behavior.

Relationship to Child *

Provide your relationship to this child.

Phone Number for submittor

E-mail Address

Enter the e-mail address for the submittor.

Smoke Detectors in the child's home? *

Yes. Tested regularly

Yes, but not tested recently.

No.

Not sure.

Leave this field blank

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CONFIDENTIAL JUVENILE FIRESETTING CONTACT FORM