Request Youth Firesetting Intervention

JavaScript Required

You must have JavaScript enabled to use this form. Please enable JavaScript and reload the page. If you cannot enable JavaScript, please contact webadmin@cityofmadison.com to provide your information.

Reporting Party Information

Name * required

Relationship to child * required

Street Address * required

Unit

City * required

State * required

ZIP/Postal Code * required

Email * required

Phone * required

Child and Caregiver Contact Information

Child's Full Name * required

Child's Age * required

Child's Grade level in school * required

Child's School * required

Names of caregiver(s)/guardian(s) * required

Street Address * required

Unit

City * required

State * required

ZIP/Postal Code * required

Phone * required

Alternate Phone * required

Email

Brief Description of Incident

Date of incident * required

Brief description of incident * required

Request Youth Firesetting Intervention

City of Madison Fire Department

Join MFD

Services

Connect with us

Our Madison – Inclusive, Innovative, & Thriving