Activity Request Form Name of event Event Day of the Week - Select -SundayMondayTuesdayWednesdayThursdayFridaySaturday Event Date Event Start Time Event End Time Requested Activity (choose one) - Select -Button/Magnet MakingFirst Aid KitsFit 'n' Fun Spin to Win WheelGlow Bug Hand WashingHandprint PoemNutrition Spin to Win WheelPrize PuttPoison and Safety Spin to Win WheelReusable Lunch BagsSend a HugSun Wheel Name of Event Location Address of event location Address of event location Address 2 City State - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle EastArmed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederate States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Will our activity be located outside? - Select -YesNo If our activity will be outside, what is the rain plan? Requesting organization Event planning contact person Phone number E-mail address Contact person for day of event Cell phone for day of event contact Date last held Number of attendees Your event must meet the following criteria: - Due to the hospital’s demanding staffing needs, the request must be completed at least 6-8 weeks prior to event date to schedule staff to work in the community. - Event must have been held previously, with a minimum of 100 attendees. - Event attendees must be parents with young children. - Event organizers will provide tables for this activity. I understand that it is the responsibility of my organization to meet the above requirements I understand that submitting this request does not guarantee St. Louis Children's Hospital's participation in this event
Activity Request Form Name of event Event Day of the Week - Select -SundayMondayTuesdayWednesdayThursdayFridaySaturday Event Date Event Start Time Event End Time Requested Activity (choose one) - Select -Button/Magnet MakingFirst Aid KitsFit 'n' Fun Spin to Win WheelGlow Bug Hand WashingHandprint PoemNutrition Spin to Win WheelPrize PuttPoison and Safety Spin to Win WheelReusable Lunch BagsSend a HugSun Wheel Name of Event Location Address of event location Address of event location Address 2 City State - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle EastArmed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederate States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Will our activity be located outside? - Select -YesNo If our activity will be outside, what is the rain plan? Requesting organization Event planning contact person Phone number E-mail address Contact person for day of event Cell phone for day of event contact Date last held Number of attendees Your event must meet the following criteria: - Due to the hospital’s demanding staffing needs, the request must be completed at least 6-8 weeks prior to event date to schedule staff to work in the community. - Event must have been held previously, with a minimum of 100 attendees. - Event attendees must be parents with young children. - Event organizers will provide tables for this activity. I understand that it is the responsibility of my organization to meet the above requirements I understand that submitting this request does not guarantee St. Louis Children's Hospital's participation in this event
