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Smoke Alarm Installation Request

  1. Smoke Alarm Installation Request

    To qualify for a free smoke alarm with installation, the homeowner must reside in the city limits of Mt. Juliet and identify as either a senior citizen, low income or have a disability. To schedule an appointment for a smoke alarm installation, complete the form below. Please allow up to 3 days for a reply.

  2. Type of Dwelling

  3. Type of Heat

  4. Rent or Own Home

  5. Are Current Alarms 10 Years or Older?

  6. Are Current Alarms Interconnected?

  7. Are any Occupants Hearing Impaired?


    I hereby authorize the Fire Department of Mt. Juliet hereinafter referred to as FDMJ to install smoke alarms in the residence listed above. I understand and agree that FDMJ is providing and installing smoke alarms as a public service in the interest of encouraging fire & life safety to help prevent needless injury, loss of life and property. I understand that FDMJ does not guarantee nor endorse any brand of smoke alarm. I also understand that FDMJ is not a seller, manufacturer or dealer in smoke alarms or that it makes no warranties with regard to these products.

  9. In exchange for accepting the free smoke alarm(s), I agree not to make any claim or demand or to file any lawsuit against FDMJ, City of Mt. Juliet Board of Commissioners or any individual employee or individual(s) serving as a volunteer with FDMJ or any individual who is involved with the Smoke Alarm Program, for any injuries, deaths, damages, costs or expenses claimed to have resulted from the smoke alarm(s) from their installation or from the instructions for maintenance and safety given at the time of installation. I hereby waive any cause of action that I may have now or in the future or that anyone else may have by or through me, arising out of the malfunctioning of the smoke alarm(s) whether or not used in accordance with the manufacturer’s instructions. I further agree to indemnify and hold harmless FDMJ, City of Mt. Juliet Board of Commissioners and its successors and assigns as to any such claim that may be brought by other parties.

  10. I further understand for these smoke alarms to be effective, the alarm will need to be checked monthly.

  11. This release from liability is binding on me and my family and all my heirs, successors and assigns.

  12. Required to receive smoke alarms and installation*

  13. Leave This Blank:

  14. This field is not part of the form submission.