Required fields are marked with asterisks (*)

Public Education Request Form

Questions: If you have any questions or require assistance, please contact Leamington Fire Services at 519-326-6291 ext. 3249.

Organization Name:

Name of Contact Person:

Email Address:

Phone Number:

Street Address:

City/Town:

Province:

Postal Code:

Location of public education if different from organization address:

Date Requested:

Time Requested:

Age of Group:

Number of Participants:

Please provide details as to what your group / organization is looking for:

Privacy Statement: Personal information on this form is collected under the authority of the Municipal Act 2001 P.S.O. c45 for the Request for Public Education in the Municipality of Leamington. This information will only be used for this purpose and will not be shared with other departments. Questions about the collection of this information can be directed to the Manager of Legislative Services/Clerk, Municipality of Leamington, 111 Erie Street North, ON N8H 2Z9. 519-326-5761.

Sign up for our eNews updates!

Subscribe to receive our municipal media releases, public notices, and council matters.