Community Event Participation

Event Name

Contact First Name

Contact Last Name

Contact Phone

Contact Email

Requesting Organization

Street

City

State

Zip Code

County
(Not Country, i.e. Summit, Stark, Portage)

Briefly describe your organization and how it serves the community.

Is the event address the same as the organization address?

Event Location

Event Street

Event City

Event State

Event Zip

Event County
(Not Country, i.e. Summit, Stark, Portage)

Did Akron Children's participate in this event previously? Yes No

Event Dates

Note: Please ensure your event is at least 6 weeks away. Your event will not be considered if less than 6 weeks away.

Day 1 :

From:

To:

Day 2 :

From:

To:

Day 3 :

From:

To:

Estimated number of attendees

Please describe the purpose of this event

Are you requesting participation? Yes No

Are you requesting sponsorship? Yes No

Outreach Request: Please complete the following:

Target Audience
(i.e. Families, Children, Parents/Caregivers, etc.)

Event Type Indoor Outdoor

Participating Vendors (comma separated):

Topics you want covered
(i.e. health topic, general hospital information, speaker, etc.)

Are you requesting Pip the Mascot to attend your event? Yes No

Are you requesting the Doggie Brigade to attend your event? Yes No

What would you like the Doggie Brigade team(s) to do at your event?

If this is an outdoor event, will there be shade for the dogs? Yes No

Will any other animals (pets, working, performance) be in attendance? Yes No

If yes, please explain:

Are you requesting a Mobile Intensive Care Unit (MICU) to attend your event?
If you are requesting the MICU, please be advised it is for visual and educational purposes only. The MICU will not provide emergency services at your event.
Yes No

Contact person day of event:

Contact person's phone:

Sponsorship Request? Complete the following:

Please submit a w-9 (PDF):

How will sponsorship funds be used for this event?

Why should Akron Children's support this event?

Please provide details of all sponsorship levels including dollar amounts and what each level of sponsorship includes:

Event Agenda/Schedule

If available, please attach a copy of the invitation (PDF ONLY)

Attach any other documentation (PDF ONLY): >

Attach any other documentation 2 (PDF ONLY): >>

Attach any other documentation 3 (PDF ONLY): >>

Community Event Participation Form

Event Dates

Outreach Request: Please complete the following:

Sponsorship Request? Complete the following:

Akron Children‘s Anywhere Mobile App

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Akron Children‘s Anywhere Mobile App

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