Contact Info  Event Organizer: First Name: Phone (Office): Last Name: Phone (Home): Title: Queen's Email: Organisation: Mailing Address (Internal Mail is acceptable)  Contact Person at Event: (must remain sober if event involves alcohol) First Name Phone Last Name Phone (at event) Queen's Email:

Event Information Event Name: Queen's / AMS / SGPS Organizational Group: Event Location: Meeting Place (if applicable): Event Date: Event Run Time: QFA Arrival Time: QFA Departure Time:: Expected Attendance: Max. Attendance:

Present at Event (check all that apply) Alcohol Access to Water * Public Restrooms * Post location for QFA Loud Noise/Music Meal for QFA ** All Ages Event    * Required if event involves alcohol or physical activity  ** Required if QFA coverage lasts for four (4) hours or more

Event Description  Briefly describe the event:     Has this event been run before? YES NO  If YES, have there been any problems in the past (describe.) If NO, are there any perceived problems?

Other Services Present Queen's Student Constables Queen's Science Constables Queen's Campus Security Kingston Police Services Kingston Regional Ambulance Private Patient Transfer Service Other (include in Event Description)

This form must be submitted to Queen's First Aid two (2) weeks prior to the event in order to ensure equal consideration for coverage. Queen's First Aid is an entirely student-run volunteer organization, and no fee is required for its services (though donations are always accepted.) In order for this Request to be processed it must be filled out in its entirety. Submission of this form is considered equivalent to a signature on the Request Contract (seen on the earlier page) For a printable (pdf) copy of the contract click here. Incomplete applications for coverage will not be accepted. The Director of QFA reserves the right of final say in the decision to cover/not cover an event.

Click here to submit