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2. Contact Information
3. First and Last Name
5. Phone Number
6. Email Address
8. Confirm Email Address
10. Address Information
12. What Jurisdiction Do You Live In?*

    1. Bayer Road
    2. Canyon Creek
    3. Chisholm
    4. Fawcett Lake
    5. Flatbush
    6. Hondo
    7. Lawrence Lake
    8. Marten Beach
    9. Mitsue Industrial
    10. Poplar Lane
    11. Slave Lake
    12. Smith
    13. Wagner
    14. Widewater
13. Address
15. City
16. Province
17. Postal Code
19. Type of Property

    1. Apartment/Condo
    2. Detached Home
    3. Duplex
    4. Mobile Home
    5. Multi-Family Home
    6. Multiplex
    7. Townhouse
    8. Other
21. Availability Information

    1. Monday
    2. Tuesday
    3. Wednesday
    4. Thursday
    5. Friday
    6. Saturday
    7. Sunday

    Best days of the week

22. Availability Information

    1. Morning
    2. Afternoon
    3. Evening
    4. Weekend

    Best time of day

24. I agree to the following terms of service*

    1. Yes
    2. No
25. Terms of Service Needed?
27. FireSmart Home Assessment – Terms of Service

    By requesting and participating in a FireSmart Home Assessment through the Municipal District of Lesser Slave River No. 124, I acknowledge and agree to the following:

    Participation

    I understand that participation in a FireSmart Home Assessment is voluntary. The assessment is intended to provide education and recommendation to help reduce wildfire risk on my property.

    Right of Entry

    I confirm that I am the owner of the property, or have the authority of the property owner, and I grant permission for a trained FireSmart professional to enter my property at a mutually agreed-upon date and time to conduct the assessment. This may include visually reviewing structures, vegetation, and surrounding areas within the Home Ignition Zone.

    Assessment Scope

    I understand that the assessment:

    • Does not include physical mitigation work
    • Does not obligate the municipality to perform any work on my property
    • May include verbal guidance and a written summary of recommended actions

    Wildfire Risk and Responsibility

    I understand that the purpose of a FireSmart Home Assessment s to help identity ways to reduce wildfire risk on a property. Wildfire is a natural and unpredictable event, and while FireSmart actions can lower risk, they cannot eliminate it entirely. Responsibility for deciding whether to implement recommendations, and for maintaining any mitigation measures over time, remains with the property owner.

    Confidentiality

    All information collected during a FireSmart Home Assessment is confidential and will be shared only with the property owner.

29. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
31. Terms of Service - Review*

    1. Yes
    2. No

    I have read the above Terms of Notice and accept to participate in a FireSmart Assessment through the Municipal District of Lesser Slave River No. 124.

33. Electronic Signature*
Leave This Blank:


35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

* indicates a required field