Injury Prevention

Safe Kids DC Event Request

Due to the large number of requests we receive, we are not always able to accommodate all requests. Requests must be received at least 3 weeks prior to the event. Requests are reviewed and approved in the order of the date they are received.

Recipient Email

Name of business, group or organization:*

Contact first name:*

Contact last name:*

E-mail address:*

Phone number:*

Name of event:*

Event address:*

Address Line 1

Address Line 2

City

State

ZIP Code

Date(s) of event (we cannot accommodate rain dates):*

Event hours:*

Location of the event:*

Indoor Outdoor

Held rain or shine*

Yes No

Event type:*

Community event or health fair (information table) Car seat check event (requires additional approval) Education session

For education session, please choose the type:

Child passenger safety Bike and pedestrian safety Home safety

Please describe available audio visual capabilities:*

Please provide a brief description of your event goals including expected attendance:*

Target audience (select all the apply):*

All Children ages 0-3 years Children ages 4-7 years Children ages 8-12 years Teens ages 13-19 years Teachers or organization staff Expectant parents Parents or caregivers Grandparents

Language(s) spoken by target audience:*

Additional comments: