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Chesterfield County Police Program Request Form
This form has been modified since it was saved. Please review all fields before submitting.
Steps
1.
Step One
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2.
Program Information
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3.
Audience Information
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4.
Program Description
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5.
Follow-up
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Step One
Please complete the form in its entirety. When scheduling your event, please allow 10 business days from the day you are entering request to your event.
Please complete the form in its entirety. When scheduling your event, please allow 10 business days from the day you are entering request to your event.
First Name
Last Name
Email Address
Phone Number
Organization
Address
City
State
Zip Code
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Program Information
Program Date
Program Date
(When scheduling, please allow 10 business days from the day you are entering request)
Day of Week
Date Flexibility
Yes
No
If 'Yes', please note additional dates in detail.
Program Start Time
Program Start Time
Program End Time
Program End Time
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Audience Information
Audience Type
-- Select One --
Children
Teenagers
Adults
Seniors
Mixed Age Group
(Select Age Group)
Expected Audience Size
1-25
25-50
50-100
100+
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Program Description
Program Type
-- Select One --
Active Shooter
Business Security
Crime Prevention Table Set-up
Frauds/scams & Identity Theft
Home Security
Internet Safety
Personal Safety
Scout Program - 1st of each month
Security Assessments
Smart Water CSI
Workplace Violence
Worship Security
Other
Program Detail
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Follow-up
Thank you for completing our program request form. <strong>Please press "Submit"</strong> and someone will contact you within ten business days. If you have questions, please call 804-318-8699.
Thank you for completing our program request form.
Please press "Submit"
and someone will contact you within ten business days. If you have questions, please call 804-318-8699.
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