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
Please select...
Development
Inclusive Education
Program - General
Program - Healthy Athletes
Program - Young Athletes
County Coordinator
Regional Director
External Request
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/Awareness
Information Booth
General Support
Other
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: V
olunteer 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...?
Please select...
Yes
No
If yes, please explain briefly
There are two digital displays available (1 indoor, 1 outdoor) - will you be utilizing them?
Please select...
Yes
No
Will you be providing content or will they need to be pre-programmed with general SONJ content?
Please select...
I will provide content to be pre-loaded (two-week notice required)
Pre-program with general SONJ content, please
Will you require any assistance working the information booth?
Please select...
No, thank you, we have plenty of staff/volunteers
Yes, please help!
If you need help, please briefly explain how many volunteers you need and how we can be of assistance
Venue Information
County/Counties
Please select...
Atlantic, Cape May, & Cumberland
Bergen
Burlington
Camden, Gloucester, & Salem
Essex
Hudson
Hunterdon & Warren
Mercer
Middlesex & Union
Monmouth & Ocean
Morris & Sussex
Passaic
Somerset
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)
Please select...
Yes
No
Are there any overhangs you are aware of under 13' tall that will need to be avoided on site or enroute?
Please select...
Yes
No
Unknown
If yes, please explain briefly
What surface will the vehicle be placed on?
Please select...
Paved, level surface
Firm and dry grass
Other
If other, please explain briefly
Is there an electric hookup available (minimum 20 amp service required)?
Please select...
Yes
No
Unknown
Is there a water hookup available for handwashing, sterilization, etc...?
Please select...
Yes
No
Unknown
Contact Information