Smoke Alarm

Request and Liability Waiver and Release


Smoke alarms save lives!
Smoke alarms that are properly installed and maintained play a vital role in reducing fire deaths and injuries.  Fire spreads fast, so working smoke alarms give you an early warning so you can get outside quickly.

Safety Tips

· Install smoke alarms in every sleeping room and outside each separate sleeping area. Install alarms on every level of the home. Install alarms in the basement.

· Test all smoke alarms at least once a month. Press the test button to be sure the alarm is working.

· Smoke alarms need replaced every 10 years.

· A closed door may slow the spread of smoke, heat, and fire.

· Working smoke alarms are an important part of a home fire escape plan.

Pike Township Fire Department provides free smoke alarm checks, battery replacements, and two (2) free smoke alarms to all Pike residents.
If you are in need of an alarm or battery check, please fill out the form, located below.

Please read and sign:

Smoke alarms are your first line of defense, but they can only save your life in they are in working condition:

· Install smoke alarm on every level of your home

· It is best to have alarms near each sleeping area

· Test alarms monthly

· Maintain your alarm according to manufacturer’s instructions


In consideration of the Pike Township Fire Department (PTFD) donating, installing, and/ or giving instructions on how to install the smoke alarm devices at no expense to myself, by my signature, I, , hereby authorize the Pike Township Fire Department (PTFD) to install or supply smoke alarms in the residence listed above. I understand and agree that PTFD is providing smoke alarms as a public service in the interest of encouraging fire/life safety and helping to prevent needless injury and/or loss of life and property. I hereby agree to indemnify and hold harmless PTFD and the officers, agents, and employees from any liability of loss, either direct or consequential, arising out of any act or omission of mine or another person’s occurring in connection with or as part of my maintenance and control over donated smoke alarms devices and the premises where they are installed.

By my signature below, I knowing and without mental reservation hereby release and hold harmless Pike Township Fire Department and its officers, agents, and employees from any and all liability, either direct or consequential, arising out of accidents, injuries, occurrences, or losses to me in connection with smoke alarm devices, their installation, maintenance, or operation.

  • Please enter your name as your electronic signature.