Please fill out this request form for event assistance from SKGH. You will normally be contacted within three business days.

Type of event/presentation	Educational Workshop (List topic below) Bike Rodeo Helmet Fitting Car Seat Check Safety In and Around Vehicles Workshop NEW: Cub Scout Automotive Safety Patch Other (Indicate below)
Name of person requesting
Agency/business requesting
Address
Email
Phone number
Location of event/workshop?
Desired date of event/workshop?
Event/workshop targeting	Public Staff/Trainees
If staff/trainees, advise type of business
If educational workshop, advise injury prevention area to target	Safety in and Around Cars Child Passenger Safety (Car Seats) Wheeled Sports (Bike, skates, etc.) Pedestrian Safety Water Safety Fire Safety Other (Note below)
We are requesting assistance with (check all that apply)	Safety Equipment (Car Seats, Helmets, etc.) CPS Technicians Other Volunteers Location/facility for event Other (Describe below)
Equipment you may need
Do you have funds to help support the event?	Yes No
Do you have volunteers/staff to assist?	Yes No
If yes to either of the above, list your available resources:
Expected number of participants?	1-10 11-25 26-50 51-100 100-250 I have no idea
Additional information
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