Recreational Burn Waiver

Please enter the required information
(Information is for Philomath Fire & Rescue use only)

This waiver is good for the year 2017

Enter the date and time (from and to) of your burn
Person Responsible: *
Person Responsible:
Enter the contact phone number of the person responsible
I certify that this information is accurate. I promise to reapply should the circumstances change (including re-applying each year if on-going) *