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Atwood Memorial Center
Special Event Risk Assessment Form
Special Event Risk Assessment Form
Requester Information
Name (person making request)*:
Email Address*:
Phone Number:
Event Information
Date of Event*:
Indicate why this event needs to be held outside normal operational building hours (if applicable):
Type of Event*:
Dance
Concert
Speaker
Fundraiser
Other
Description of Event*:
Name of Performer/Speaker:
Location Information
Has this event previously been hosted on campus or any other place?*:
Yes
No
If yes, where?
When?
Estimated Number of Attendees*:
Target Age Group of Attendees (Indicate all that apply):
Under 18 years:
%
18-24 years:
%
Over 24 years:
%
Expected Attendees:
SCSU community:
%
General public:
%
Advertising
How is the event being advertised?
Campus
Community
Electronic Media
Facebook
Other:
Provide link if applicable:
Contact Information
Contact Person(s) (on site at event):
Cell Phone:
Adviser's Name*:
Advisor's Phone*: