Event Coverage Request Form

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Please complete this request form as accurately as possible. In order for our volunteers to be effective in providing this service, we request as much information as possible about your event.

We also require at least three weeks notice prior to the day of the event.

Due to the amount of requests that St. John Ambulance receives, completing the form below does not guarantee that volunteers will be present at your event. Please note that if your event passes over a mealtime, food needs to be provided for our volunteers. When providing a donation, please include the cost of gas to get to your event.

Required Fields (*).
For inquires for Community Services please contact our Branch Manager at leedsgrenvillelanark@sja.ca or by phone, 613-342-2974.

Agency Organization Information

Name of Group / Organization *

Contact Person *

Address *

City *

Postal Code *

Phone Number *

E-Mail Address

Event Logistics

Are you be able to provide the following for our volunteers in order for us to be prepared to serve your participants and be equipped to handle a variety of situations.

Designated First Aid Station / Sheltered Area

Cubed Ice

Clean Drinking Water

Washroom Facilities

Parking for Volunteers

Donation Provided

If you said yes to a donation and you would like a reciept for it please fill out the fields below

Name / Organization on Reciept

Mailing Address for Reciept

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