<form-template> <fields> <field type="text" subtype="text" required="true" label="Name" class="form-control text-input" name="text-1656971112964"></field> <field type="text" subtype="text" required="true" label="Cell Phone # 000-000-0000" class="form-control text-input" name="text-1656971126084"></field> <field type="text" subtype="text" required="true" label="Alternate Phone #" class="form-control text-input" name="text-1656971147358"></field> <field type="text" subtype="text" label="Email " class="form-control text-input" name="text-1656971169765"></field> <field type="select" required="true" label="I intend to set fire and burn (choose)" class="form-control select" name="select-1656971198701" multiple="true"> <option value="YES - Grass/Slough" selected="true">Grass/Slough</option> <option value="YES - Stubble/Crop">Stubble/Crop</option> <option value="YES - Bush ">Bush </option> <option>Other </option> </field> <field type="text" subtype="text" label="If other please explain what you are burning (building, piles, etc.)" class="form-control text-input" name="text-1656971396496"></field> <field type="text" subtype="text" required="true" label="Legal Description" class="form-control text-input" name="text-1656971429094"></field> <field type="date" required="true" label="Max of two weeks starting on " class="form-control calendar" name="date-1656971666777"></field> <field type="date" required="true" label="Ending on " class="form-control calendar" name="date-1656971712969"></field> <field type="checkbox-group" required="true" label="I will adhere to the conditions and provisions of the wild fire act and municipal by-laws including " class="checkbox-group" name="checkbox-group-1656971781283"> <option value="YES - Contact the MB Crop Residue Burning Line (204-745-5646) if burning during April 1 - November 15 for authorization." selected="true">Contact the MB Crop Residue Burning Line (204-745-5646) if burning during April 1 - November 15 for authorization.</option> <option value="YES - Monitor and keep fire under control at all times.">Monitor and keep fire under control at all times.</option> <option value="YES - Bear responsibility for all property damage resulting from burning done under this permit.">Bear responsibility for all property damage resulting from burning done under this permit.</option> </field> <field type="text" subtype="text" required="true" label="I agree to all mentioned above (yes or no)" description="Write Yes or No" class="form-control text-input" name="text-1658942183882"></field> <field type="paragraph" subtype="p" label="All permits are forwarded the Fire Chief and you will be contacted if there are any questions or concerns, otherwise your permit can be assumed approved. *If you expect your fire to be substantial (will be seen from a distance), please text 204-825-7804 ASAP." class="paragraph"></field> </fields> </form-template> Submit Submitting...