His/Her Hydrant Location: _______________________________________________________

For the adoption of "___________________________________________" the Hydrant (name).

Adoptive family member’s names: ________________________________________________

Adoptive family’s home address: _________________________________________________

Adoptive family’s telephone number: ______________________________________________

I / We do herby pledge to keep ____________________________ the Hydrant clear of snow and overgrowth with a 3 foot radius around him / her all winter and summer long.

I / We know that taking care of our hydrant is only part of fire safety. There are many other important fire safety practices that should be practiced in the home.

I / We _____________________________________ do solemnly swear that:

We have working smoke detectors on every level of our home and we tested our smoke detectors on __________________________________ (date).

We replace the batteries at least once a year in our smoke detectors. ___________________

We have a fire escape plan and we have practiced it. _______________________________

Our meeting place outside the home where we will all gather in case of a fire is _______________________________________________________________.

All family members know to dial 9-1-1 for Fire, Police and Ambulance.

We never leave candles unattended.___________________________________________