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2. Instructions

   Community Groups may use this form to request assistance from Lincoln County Community Emergency Response Team (CERT) teams.

   Request must be submitted at least four business weeks prior to your event. You will be contacted following the review of your request to discuss your request in further detail. Filling out this request does not assure approval. A confirmation letter will be issued if approved.

4. Requester Name
5. Date Requested
   Date Requested
7. Phone
8. Email
10. Event Name
11. Event Type
    -- Select One --Assist Emergency Management PlanningAssist Fire ServiceAssist TEEN CERTFair or FestivalParadePreparedness OutreachRe-CERTificationReadiness FairOther
13. Other
15. CERT Chapter

    1. North Lincoln
    2. Depoe Bay
    3. Newport
    4. South County
17. Event Contact
18. Phone
19. Email
21. Event Start and End Date and Time
    Event Start and End Date and Time Start Date

    Event Start and End Date and Time Start Time

    —

    Event Start and End Date and Time End Date

    Event Start and End Date and Time End Time
23. Event Location
25. Event Tasks
    -- Select One --Answer PhonesAssist at EventDisseminate InformationFirefighter RehabFood ServiceGreeterHAM Radio CommunicationsMonitor Social MediaNeighborhood OutreachPromote Emergency ManagementRunnerScribeSurveyingWater/1st Aid StationWeather SpotterOther
26. Other
28. Will there be Refreshments?

    1. Yes
    2. No
29. Snacks or Meals?

    1. Yes
    2. No
31. Insurance Coverage?

    1. Yes
    2. No
32. If yes, please provide a copy of the policy endorsement and type of coverage.
34. Event Security on site?

    1. Yes
    2. No
35. Is alcohol allowed at this event?

    1. Yes
    2. No
37. How many attendees are expected?
39. Required Information

    If request is approved the following information will be required:

    For Festivals or Fairs

    • Boundaries
    • Layout of booths, tents, etc., labeled
    • Location of barricades and vendor access points
    • Show where CERT can put information and incident command tents can be located.

    For Parades

    • Exact parade route, with street names
    • Location of parade staging for participants
    • Where participants will go at the end of the parade
    • Mark where CERT personnel will be stationed
Leave This Blank:


41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit

* indicates a required field