Action Center / Youth Firesetter Intervention Program / Davenport, Iowa

Youth Firesetter Intervention Program

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The Davenport Fire Department and the Fire Prevention Bureau are offering our community a Youth Firesetter Intervention Program. Intervention Specialists are prepared to assist families where firesetting may be taking place or to aid with children who have witnessed a fire. Our intake and interview will determine the next level care that is needed in the home.

The Youth Firesetter Intervention Program partners with local education facilities, law enforcement, and other community agencies to assist families with obtaining the appropriate social services for success.

There is no charge for this service and all information is kept strictly confidential.

* Denotes a required field

Name of Parent(s)/Guardian(s) (First and Last Name)*

Home Address*

Parent/Guardian Phone #1*

Phone Area Code-Phone 3-Phone 4 ext Extension

Parent/Guardian Phone #2*

Phone Area Code-Phone 3-Phone 4 ext Extension

Parent/Guardian Email*

Name of Youth (First and Last)*

Please Do Not Complete The Following Field

Age*

Grade*

School Name*

Referral Made by (First and Last Name)*

Referral Contact Information (Phone or Email)*

Tell us about the fire. Why is this youth being referred? Provide a brief description of the incident in which this youth is being referred to Youth Fire Intervention.*

Approximately when did this fire happen?*

MonthDay Year, HourMinute : AM/PM

Did any of the following occur with the fire set by the youth? Check all that apply.*

Youth Firesetter Intervention Program

Youth Firesetter Intervention Program

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