FSH Request Form | Blank Children's Hospital in Iowa

UnityPoint Clinic - Express

180 Jordan Creek Parkway, Suite 120
West Des Moines, Iowa 50266

Closed Patients
Waiting Now

UnityPoint Clinic Urgent Care - Altoona

2720 8th St. SW
Altoona, Iowa 50009

Closed Patients
Waiting Now

UnityPoint Clinic Urgent Care - Ingersoll

2103 Ingersoll Ave., Ste. 2
Des Moines, Iowa 50312

Closed Patients
Waiting Now

Urgent Care - Ankeny

3625 N. Ankeny Blvd.
Suite E
Ankeny, Iowa 50023

Closed Patients
Waiting Now

Urgent Care - Lakeview

6000 University Avenue
Suite 101
West Des Moines, Iowa 50266

Closed Patients
Waiting Now

Urgent Care - Merle Hay

4020 Merle Hay Road
Suite 100
Des Moines, Iowa 50310

Closed Patients
Waiting Now

Urgent Care - Southglen

6520 SE 14th St.
Des Moines, Iowa 50320

Closed Patients
Waiting Now

Urgent Care - Urbandale

2901 86th Street
Urbandale, Iowa 50322

Closed Patients
Waiting Now
Blank Children's Hospital

Fire Safety House Request Form

If you'd like the Fire Safety House to visit your area for Fire Safety Education or for Severe Weather Training, please complete and submit the form below. 


TRAILER AVAILABILITY:

You may check the  availability of the Fire Safety House by viewing the public event calendar. Please note this calendar is updated weekly to add new events.  

TERMS AND CONDITIONS:

Please review the Terms and Conditions documents prior to submitting your request. By submitting an event request, you agree to these Terms and Conditions.  

Fire Safety Education Terms and Conditions

Severe Weather Education Terms and Conditions

SUGGESTED DONATION:

Please know that while the Fire Safety House is available to use free of charge a donation is suggested. Donations of any amount help to keep the Fire Safety House program visiting communities in Iowa just like yours!  Donations of the following amounts assist with:

  • A $150 donation provides program supplies for a one day event
  • A $325 donation provides program supplies and fuel for a one day event
  • A $500 donation provides pay for program drivers, trailer maintenance and fully supports the trailer for a one day event 


PLEASE FILL IN ALL FORM BOXES - The form will not submit if you do not fill in all boxes. 

Important! * Required Fields (Please note all * fields must be completed in order for the form to successfully submit)



          
 
  
      By clicking submit, you acknowledge that you've read and agree to the Term and Conditions of Use. If your organization is already a sponsor please fill in the box with "current sponsor"