Request for Police Service Form

Requestor Information

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Date of Request*

Requestor*

Requestor's Email*

Work Phone*

Cell Phone*

School or Department*

Sponsoring Organization or Club*

Event Information

Name of Event*

Date of Event*

Brief Description of Event*

Event Location*

Room / Section*

Estimated Attendance*

Please enter a number greater than or equal to 1.

Number of Police Officers Requested*

Please enter a number greater than or equal to 1.

Describe the specific need for police officer presence.*

Event Contact Person*

Title*

Work Phone*

Cell Phone*

Specific Needs Requested

If so please describe*

If so please describe in detail below: (The location it will be received, storage, if it will be transported to another location throughout the event or at the end, and how much cash is expected).*

Please explain your answer.*

Event Analysis

If yes, please describe in detail below.*

Please click submit. Once submitted, a police representative will contact you within 72 hours to discuss policing services. No policing services will be scheduled until this representative has contacted you. If you have any questions, or if a representative has not contacted you within 72 hours, please call the CBN / Regent Police Department at 757-226-2075. The initial point of contact for events is Lieutenant W. Oliver. Thank you.

Name

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Request For Police Service Form

Requestor Information

Event Information

Specific Needs Requested

Event Analysis