SONJ RV (Mobile Health Vehicle) Request Form

SONJ RV (Mobile Health Vehicle) Request Form

Please submit this form with as much information as possible regarding the event including location, logistics, and points of contact. Thank you.

Name

Department

Event

Event date

Arrival Time

End Time (Estimate if not exact)

What is the purpose of our presence?

Health Screenings (3 month lead time required)Branding/AwarenessInformation BoothGeneral SupportOther

If other, please explain briefly

Types of screenings requested (select all that apply)

Fit Feet (Podiatry)Healthy Hearing (Auditory)Opening Eyes (Optometry)Special Smiles (Dentistry)MedFest (Physical)

Estimated number of athletes to be screened.
Capacity Limitations: Only 1-2 athletes can be on the RV at once. Screening numerous athletes may take several hours due to this limitation.

Please Note: Volunteer doctors, clinicians, and assistants require at least 3 months' notice to coordinate their attendance and their participation is not guaranteed as they are volunteering their time. If you know of any healthcare professionals interested in volunteering with SONJ, please direct them to contact our Health Programs Director, Amelia Hamilton at ARH@sonj.org and provide their contact information below.

Will you require any additional setup needs outside the RV - i.e. tables, chairs, tent, PA/speakers, etc...?

If yes, please explain briefly

There are two digital displays available (1 indoor, 1 outdoor) - will you be utilizing them?

Will you be providing content or will they need to be pre-programmed with general SONJ content?

Will you require any assistance working the information booth?

If you need help, please briefly explain how many volunteers you need and how we can be of assistance

Venue Information

County/Counties

Address

Main Point of Contact (Include email, cell phone, if available)

When does the RV need to be dropped off and picked up?

Parking Requirements

Ensure there is ample parking for the RV, which measures 33'x8' and takes up about 4 parking spaces. The vehicle requires a 13' overhang clearance and a paved, level surface is preferred, however, a grassy surface is permitted if firm and dry.

Is there ample space for parking the vehicle (33'x8', or at least 4 parking spaces)

Are there any overhangs you are aware of under 13' tall that will need to be avoided on site or enroute?

If yes, please explain briefly

What surface will the vehicle be placed on?

If other, please explain briefly

Is there an electric hookup available (minimum 20 amp service required)?

Is there a water hookup available for handwashing, sterilization, etc...?

Contact Information