Clarkson University EMS - Event Coverage Request

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Please fill out the form below to request Clarkson EMS standby coverage at an event.
Please try to submit event requests at least two weeks before the event.

Important Note: Clarkson EMS attempts to provide coverage for all Clarkson affiliated events on Clarkson's Hill campus that require and/or request EMS standby coverage. However, as an all-student/staff volunteer service with limited staffing, it is not always possible for Clarkson EMS to provide event standby coverage even when the event is requested well in advance. We will always try our best to organize event crews, but in the event we are unable to do so, we will try and let you know as soon as possible and direct you to other area resources.

Contact Person's Name *

Contact Email *

Contact Phone *

Please include in the format of ### - ### - ####

Organization or Group Requesting Service *

Date of Event *

YYYY

Name of Event *

Location of Event *

Door Opening Time *

If event is outdoors, list the expected arrival time of the first patrons. Example: 11:00 AM

Time

Actual Starting Time of Event *

Example: 11:00 AM

Time

Ending Time of Event *

Ending Time of Event

Time

Event Description *

Please describe the event, and list unique safety considerations for your event (i.e loud music, low lighting, large animals, alcohol service, etc.)

Were you referred to our services by Clarkson Campus Safety & Security (CS&S)? *

Yes

Please read and check the first two boxes. Please read the third box and check if applicable

5185784059

I acknowledge that this request, regardless of how early it is submitted, does not guarantee that Clarkson University EMS will be able to provide standby service for my event

I agree to call or text the phone number above if I do not receive a response of any sort to my request one week prior to the event

If my event is less than two weeks away, I agree to call or text the phone number above within 12 hours.

Required

Questions or Comments

If you have any questions or concerns, please email me at cuems@clarkson.edu

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