2. Dayton, Ohio, has a strong sense of community and is often referred to as the city of neighbors. What better way to be a neighbor than to check on our seniors and people with disabilities? The Dayton Fire Department wants to be a part of that neighborhood by working with our vulnerable residents by calling and/or texting them to ensure they are ok.

   Members of the Dayton Fire Department will contact people Monday through Friday to ensure that they are ok and well. Depending on the need of the resident, this will be an automated text or phone call from a trained member of the City of Dayton Fire Department.

   The City of Dayton and the Dayton Fire Department need more information to register you or your loved one for the Dayton Senior Safe Program. Please fill out the form below, and we will be in contact with you as soon as possible. We look forward to working with you.

4. Full Name*
6. Address*
8. City*
9. State*
10. Zip*
12. Cell Phone Number*
13. Home Phone Number
15. Emergency Contact Full Name*
16. Relationship*
18. Emergency Contact Phone Number*
20. Are you interested in a residential lock box?*

    1. Yes
    2. No
22. Are you interested in a prescription reminder text?*

    1. Yes
    2. No
24. Do you need a smoke or carbon monoxide detector?*

    1. Yes
    2. No
26. Are you interested in a home safety check visit?

    1. Yes
    2. No
Leave This Blank:


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

    This field is not part of the form submission.

30. Submit

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